
Class 

Book 

Copyright]^", 



CPIVRIGHT DEPOSIT. 



SLEEP AND THE SLEEPLESS 



SLEEP AND THE 
SLEEPLESS 



SIMPLE RULES FOR 
OVERCOMING INSOMNIA 



BY 

JOSEPH COLLINS, M.D. 

Physician to the Neurological Institute of New York 



•new l^orft 

STURGIS & WALTON 

COMPANY 

1912 



0^ 






Copyrteht, 1912 
By STURGIS & WALTON COMPANY 



Set up and electrotyped, Published, October, 1912 



©CI.A328329 



PEEFACE 

The aim of this book is to help sleepless peo- 
ple to cure themselves, to tell them practically 
and specifically what should be done in the way 
of food, exercise, baths, dress, and mental atti- 
tude that they may capture sleep. The book 
is essentially practical and free from puzzling 
scientific terms. It sets forth what can be done 
by each for himself without the help of nurse 
or doctor. Although addressed to the layman 
in his own tongue and free from technical 
terms, it is based upon the latest results of sci- 
entific study and represents the essence of 
a wide experience. It constitutes a reliable 
handbook for insomniacs who, if they follow it 
as a guide, should find relief and ultimate cure. 



CONTENTS 



CHAPTER PAGE 

I Some Chaeacteristics of Sleep 3 

II Degrees and Varieties of Insomnia .... 13 

III Theobies and Phenomena of Sleep .... 23 

IV Insomnia Due to Physicai- Causes .... 35 
V Insomnia from Mental Causes 47 

VI Dreams 57 

VII The Requisite Quantity of Sleep 65 

VIII Surroundings Conducive to Sleep 73 

IX Treatment 81 

X Principal Curative Agencies 93 

XI Opiates and Narcotics 105 

XII Hypnotism and Suggestion 117 

XIII Reading as a Soporific 125 



SLEEP AND THE SLEEPLESS 



SLEEP 
AND THE SLEEPLESS 

CHAPTER I 

SOME CHAEACTERISTICS OF SLEEP 

Op all the remarkable and wonderfully adjusted 
elements and agencies that go to the making up 
of the human machine, and that contribute to 
its maintenance in proper working order, none 
is so essential as sleep. 

Thanks to its magic restorative virtue, the life 
force that we expend during the day is re- 
newed in us during the night. The wear and 
tear of sixteen hours of work and play is re- 
paired in eight hours of recuperative slumber. 

During the day, life flows out from us at every 

muscular or mental effort. During the night, 

it flows in with every sleeping inhalation. And 

we do not live by days or years, but hy the 

3 



4 SLEEP AND THE SLIEEPLESS 

margin between what we expend of our vitality 
during the day and what we gain during the 
night. 

So long as man was satisfied to spend during 
the day only as much energy as he could make 
up at night during sleep, the race was vigor- 
ous and long-lived ; old age began at eighty. In 
these strenuous days, however, work and play 
are both under such heavy pressure that twice 
as much life flows out of us during the day as 
flows into us during the night, and old age be- 
gins at forty. 

The Approach of Insomnia.— The man who 
crowds sixteen hours of labour into eight, or 
eight hours of dissipation into four, may delude 
himself for a while into the belief that as he is 
working and playing harder, so he is sleeping 
harder. Unfortunately this is a fallacy. 

He will not realise at first that he is no longer 
living on his income of energy but that he is eat- 
ing up his capital and making daily inroads into 
his reserve supply of vital force. 

Because he is sleeping the same number of 
hours, he will fancy that each hour has the same 
recuperative value that it had before he began 



CHAEACTEEISTICS OF SLEEP 5 

"oiling the wheels of time" and inflating 
his sixteen hours of wakefulness into thirty- 
two. 

He will soon find, however, not only that his 
nights do not offset his days but that they con- 
tain less and less restorative balm. Each morn- 
ing he will rise less refreshed, each night he will 
feel more exhausted. And then, as his daytime 
efficiency diminishes his nocturnal restlessness 
will increase. 

He will no longer be able to "steep his senses 
in f orgetfulness " and "the cares that infest the 
day" will tug at his pillow through half the 
night. From eight hours sleeping he will come 
down to four and then to shreds of fitful and 
dream-haunted slumber which, pieced out min- 
ute to minute, will represent less than two 
hours of unconsciousness. 

Soon he will fancy that even this brief and in- 
adequate surcease has been curtailed. He will 
grow convinced that sleep cannot come to him 
and under the fret of this one idea he will grad- 
ually come to a complete forgetfulness of how to 
sleep. Pity the man or woman who has 
reached this stage. Few if any of the ills of 



6 SLEEP AND THE SLEEPLESS 

life obscure so completely the sunshine of hap- 
piness as does insomnia. 

The unfortunate victim will begin the day 
under the shadow of doubt. Before it is yet 
noon, he will be obsessed with the idea that the 
coming night will not bring him sleep. Behind 
every thought, will lurk the fear that the hours 
of darkness must be spent in restless tossing. 
He will become haggard of face, wandering in 
attention, impatient in manner, hesitating in 
speech and bungling in mind. 

Life will flow out of him not only during the 
hours of daylight, but during every minute of 
his wakefulness and he will suddenly find him- 
self confronted with the realisation that his re- 
serve supply of energy and vital strength is ex- 
hausted. 

If, in the face of this calamity, the victim 
pause long enough to analyse his condition, he 
will find that it is due in large measure to the 
crumbling of his will power, overwhelmed as it 
has been day after day by tasks beyond human 
endurance. If the modern galley slaves of busi- 
ness who take pride in being likened to *'live 
wires" could achieve the impossible and ex- 



CHARACTERISTICS OF SLEEP 7 

tinguish the life in the wires upon retiring for 
the night, all might be well. A fresh current 
would flow into them as they slept and the 
dynamo would find itself recharged in the 
morning. Unfortunately the wire keeps sput- 
tering all night and ultimately burns itself 
out. 

The sufferer from insomnia may take himself 
in hand before he is totally bankrupt of will 
power. He may decide to expend less energy 
during his waking hours, hoping thereby to les- 
sen the daily overdraft upon his reserve 
strength. If he still has a sufficient balance of 
vitality to his credit this may be the turning 
point and in time he may find himself sleeping 
normally. Too often, however, even when the 
high pressure of business and fast living has 
been removed, sleep remains away. At this 
stage the victim has forgotten how to sleep. 

Fortunately, sleep is a habit so deeply in- 
grained that it can be picked up again easily if 
we apply ourselves to the task with system and 
perseverance. To show how this may be done 
is one of the objects of this book. 

In order that sufferers from sleeplessness 



8 SLEEP AND THE SLEEPLESS 

may be able to rid themselves of their harassing 
infirmity, it is necessary that they should know 
something of the natural history of sleep and of 
the causes of insomnia. These may be stated 
briefly and simply, but first it is necessary to 
state definitely that the cultivation of mi effect- 
ive will is perhaps the most important step to- 
ivards relief. The capacity to exert the will and 
even the capacity for concentration upon which 
such exertion depends are often greatly dimin- 
ished. These must be built up. 

The Will to Sleep.— It is to those who feel 
the shadow of this apparently needless affliction 
settling down upon them and who have not yet 
despaired that this message is addressed. For 
those who can still think clearly and not only 
search with some measure of keenness for 
causes but also take up patiently and persever- 
ingly the cultivation of the right attitude toward 
life, it can be said that there is such a thing as 
a will to sleep. When this is but an instinct, 
which has not grown into a conscious will as 
the other instincts have, but which has come to 
an early death through neglect, then such a will 
must be built up. If there was such a will in 



CHARACTERISTICS OF SLEEP 9 

early days of development and it has been lost, 
then it must be revived and cultivated. 

It must be borne in mind that no one comes off 
victorious in any battle who does not enter the 
lists with the determination to succeed. This is 
said not only as an incentive but as a warning, 
for just now, some of the newest foes of the in- 
somniac are found in the home of his friends. 
As the victim tries in desperation of mind to 
reason out why he, a strong man with a will ef- 
fective in many undertakings, cannot lay com- 
pelling hands on sleep, too often he will find his 
initial vexation increased by the lack of logic of 
those who advocate this or that remedy. Par- 
ticularly is this true when hypnotism is pointed 
out to him as a means to obtain sleep. 

When asked, as a preliminary to acquiring the 
disposition to sleep, to abandon his full con- 
sciousness and put his mind at the disposal of 
another, he may well hesitate if he realises that 
he is already the victim of a negative condition 
and that what he is seeking is a capacity for af- 
firmation. When, on the other hand, he is told 
that what he must endeavour to do is to acquire 
the power of discarding demoralising thought 



10 SLEEP AND THE SLEEPLESS 

and fancies that haunt him and keep him from 
fulfilling his physiological resting, he realises 
that he is being urged to affirmation. Espe- 
cially is this true if he is told that not only must 
he compel himself to discard these terrors of the 
night but that he must replace them with purer, 
higher and restraining thoughts. Such proce- 
dure is the fabric of all moral progress and it is 
the basis of cure of many functional nervous af- 
fections. The power of the will over thoughts 
varies with the individual as everj^one knows. 
There are many thoughts which we would ban- 
ish from the mind forever were it possible to do 
so. But they come in stealthily and oftentimes 
concealed with a flood of others like an unwel- 
come guest who gets in the house to which he 
has been forbidden when the doors are thrown 
wide open for a public reception. The oftener 
such a guest is forcibly ejected, the less often 
will he present himself. It is much the same 
way with unwelcome demoralising thoughts. 
The mind that is constantly dwelling upon past 
faults or considering with fear what the future 
holds in store must be disciplined. Discipline 
does not imply punishment. It may mean so- 



CHABACTERISTICS OF SLEEP 11 

ciety, travel, diversion, play, religion. But be- 
fore any of these, save the last, can do any 
good, the individual must realise that he was not 
created to punish himself, but simply to be use- 
ful and happy and to make others useful and 
happy. Most of us have an underlying belief 
that mankind is right in declaring throughout 
its history that happiness, the sort of happiness 
that makes life worth living, is bound up with 
effective effort. 

The real test of any cure for insomnia is the 
degree and kind of happiness it leaves behind it. 
Happiness of an indefinite sort is not enough for 
the man who discriminates ; he must have hap- 
piness of a kind that will wear and which is a 
quid pro quo in the market-place where he 
trades endeavour for satisfaction. It is the 
toughness of the fibre of his happiness, its power 
to endure a shock and stand before the blazing 
light of reality, which will determine whether it 
has been worth while to fight the battle against 
sleeplessness. To-day fewer men than ever be- 
lieve that this land of happiness can be the pos- 
session of any man who has not added to his 
power to believe, the power to will the effective 



12 SLEEP AND THE SLEEPLESS 

accomplishment of independent tasks. Tiie 
man who knows what he wants and why he 
wants it, the man who believes in the legitimacy 
of his desire to possess a will to sleep, who 
wants this not simply because he is suffering a 
present annoyance but because he longs to be 
set free for more effective work, may take 
heart. His suffering can be cured. 



CHAPTER n 

DEGREES AND VARIETIES OF 
INSOMNIA 

The capacity to sleep can be acquired by effort 
in the same way as the capacity to think con- 
cretely or to run without getting out of breath. 
We know that many men whom we now class 
among the immortals possessed this capacity to 
sleep to a most unusual degree — Shelley, Na- 
poleon, Brougham. 

It is related of the poet that no matter how 
harassing the family relationship became he 
could go to sleep at will. It seems incredible 
that a man of the energy, enthusiasm, activity, 
vigour and variety of intellect and ambition of 
Brougham could also switch on sleep as one 
turns on electric light. It is not unlikely that it 
was to this ability that he owed his remarkable 
longevity, or rather the retention of his facul- 
ties until four score years and ten. When one 
recalls the physical and mental activities of this 
13 



14 SLEEP AND THE SLEEPLESS 

extraordinary man one wonders how the work- 
ings of such a brain could be shut off and turned 
on at will. 

Circumstances and things apparently trivial 
may cause insomnia. A celebrated German 
physician, Strumpell, has published a story of a 
patient afflicted with a disease which made him 
insensitive to touch and temperature and who 
went to sleep immediately when his eyes and 
ears, the two remaining sense organs, were 
closed. 

Convenience directed us to work in the light 
and sleep in the dark, and custom has confirmed 
these directions, adding to darkness perfect 
quiet and bodily comfort. But man can learn to 
sleep without these easy introductions. Boiler- 
makers grow accustomed to taking their rest be- 
neath the clang of their comrades' rivet-ham- 
mers, and the overworked, busy practitioner of 
medicine has often to get his sleep by taking 
naps of a few minutes' duration as he is driven 
from the home of one patient to another. 
Everyone knows how astonished the countryman 
is on coming to the metropolis to find that his 
city cousin sleeps peacefully through the clang 



VAEIETIES OF INSOMNIA 15 

and thunder of cable cars, elevated railway 
trains, and the countless noises of the street 
which to his bucolic soul make night hideous. 
On the other hand, the city cousin who visits the 
old farm finds the crowing of cocks, the barking 
of dogs, the interminable conflict of *'Katy did" 
and '^Katy didn't," and the early twittering of 
birds infinitely worse than the roar and clang of 
the city. The question is merely one of habit as 
admirably set forth in the ancient ditty : — 

An old lady who lived by the shore, 
At length got so used to the roar 
That she never could sleep 
Unless someone would keep 
A-pounding away at the door I 

Three Classes of Insomniacs. — The causes of 
insomnia are countless, varying from an unkind 
word to a serious mental or bodily illness. It 
facilitates recognition of the causes of insomnia 
to classify the conditions to which it bears rela- 
tionship. For instance, one class of patients 
have great difficulty in getting to sleep. If they 
are allowed to prolong their slumbers into 
morning, there are usually no ill consequences, 



16 SLEEP AND THE SLEEPLESS 

but as duty compels them to rise at a stated 
time, many of them suffer from the effects of 
curtailed sleep and it is this class particularly 
in whom fear of not getting to sleep and dis- 
tressing impotent efforts to secure sleep com- 
bine to exhaust the victim's strength and energy. 
This variety of sleeplessness has a fairly uni- 
form causation. It is dependent upon mental 
conditions, excitement, fear, dread, anxiety, 
overwork and use of intoxicants or stimulants, 
particularly tea. Not infrequently such in- 
somnia has its beginning in intentional and de- 
liberate curtailment of sleep, in order to give 
more time to work. 

It is the commonest form of sleeplessness in 
those who carry their troubles and their labours 
to bed with them. It is the sleeplessness which 
afflicts the individual who has engaged in an 
arg-ument or altercation where perhaps his van- 
ity has been wounded or his feelings hurt. It 
is the form of insomnia experienced by the 
anxious mother, the possessor of a weak heart, 
or by the individual who has recently been lis- 
tening to the plaudits attending his efforts. 

Another class of insomniacs is made up of 



VAEIETIES OF INSOMNIA 17 

those who experience a profound drowsiness 
terminating, often against the patient's will, 
in unrefreshing slnmber of variable duration 
which comes on early in the evening, followed 
either by repeated and apparently causeless 
awakenings, or by abrupt and complete awaken- 
ing with mental alertness, but often with depres- 
sion of spirits. Here again the ego which 
dominates the individual takes great delight in 
unwinding a scroll upon which is written in glit- 
tering letters a record of the infirmities of the 
spirit, or upon which is painted by the unf orget- 
ting brush of memory certain bitter or miser- 
able incidents in the past, the contemplation of 
which revives the old emotions, awakens the old 
suffering and banishes all possibility of sleep. 
Insomnia of this kind is most commonly associ- 
ated with some variety of self-poisoning, usu- 
ally arising from indigestion and constipation 
and what is technically called "auto-intoxica- 
tion." Occurring in persons after middle life, 
it is not infrequently an expression of impaired 
elasticity of the blood vessels, the beginning of 
that disease which is now having what might be 
called a conventional popularity, viz. — arterio- 



18 SLEEP AND THE SLEEPLESS 

sclerosis. This form of disturbed sleep is of 
course much more common in so-called nervous 
persons, especially in those who take alcoholic 
stimulants, than in phlegmatic individuals. 
Physicans have found out that the early mani- 
festations of disorder of the circulation of the 
blood may be recognised more unmistakably by 
certain methods of instrumental examination 
than by any other means. They have learned 
also that this condition can be cured. 

The third variety of sleeplessness, classifying 
sleeplessness now according to the time of its 
occurrence, is technically spoken of as dysom- 
nia in contradistinction to insomnia. Here the 
adequate number of hours is apparently ob- 
tained but there is lacking that feeling of re- 
freshment and invigoration which should come 
after normal sleep. The tired body and the 
exhausted mind craves sleep so keenly that at 
first it comes on very profoundly and then ab- 
ruptly, the victim awakens to find that his mind 
is carrying on its particular problems at exactly 
the same point, and in quite the same way, as be- 
fore he went to sleep. 

Insomnia in Health and in Disease. — Insom- 



VAEIETIES OF INSOMNIA 19 

nia in one form or another accompanies nearly 
every disorder of the health, but it occurs also in 
individuals who are entirely well. In the ma- 
jority of instances it is a state of mind founded 
in fear and apprehension. But frequently it 
can be ascribed to a direct and immediate phys- 
ical cause, indigestion for instance, or tooth- 
ache. 

Of all the physical causes of insomnia, as dis- 
tinct from the mental, none is so positive or 
prevalent as indigestion. We take so many lib- 
erties with the functions of our body that we 
easily forget that the digestive tract is the main 
road to health and efficiency. Very few have 
the good fortune to reach middle age without 
having experienced some disorder of digestion. 
The effects of such disorder may be revealed in 
many ways, but the commonest way, especially 
in persons with what is popularly called the 
nervous temperament is through disorder of 
sleep. 

Sleep disturbances from indigestion are apt 
to occur in brain-workers, in persons of a 
sedentary occupation and in those who are ex- 
posed to harassing, anxious and depressing emo- 



20 SLEEP AND THE SLEEPLESS 

tional experiences. Anxiety, worry, consterna- 
tion, terror and grief, emotions whicli most of 
lis experience at one time or another, have their 
effect first upon the digestion and then in turn 
upon the various other functions of the body. 

Although I purposely refrain from enumerat- 
ing the various diseases which cause insomnia, 
special mention must be made of the sleepless- 
ness resulting from influenza. In my experi- 
ence it is most obstinate and taxes the resources 
of the patient and of the physician. 

Insomnia may be, and often is, an accompani- 
ment of certain specific diseases both acute and 
chronic, but this sort of insomnia is almost in- 
variably self-limited and ceases when the dis- 
ease terminates. In other cases insomnia is 
due to intoxication from poisons arising within 
the system, such as those accompanying disor- 
ders of digestion, gout, rheumatism, diabetes 
and excessive bodily fatigue. It is much more 
often, however, the result of poisons taken into 
the system, such as tobacco, tea, coffee and 
drugs, such as strychnine and so-called nerve ton- 
ics of one kind or another all of which contain 
circulatory excitants. That certain stimulants, 



VAEIETIES OF INSOMNIA 21 

particularly tea and coffee, are powerful agen- 
cies in the prevention of sleep is undisputed. 
There are many persons, however, who can 
drink a cup of strong black coffee and immedi- 
ately proceed to bed and to sleep as though they 
had quaffed the cup of Lethe. Probably coffee 
is a more potent agency in causing wakefulness 
than tea because it is a more fundamental stim- 
ulant and its effect upon the heart and blood- 
vessels is more pronounced. Tea, however, has 
a unique capacity for causing wakefulness in a 
certain type of nervous individuals, the inter- 
mediate cause being generally flatulent dyspep- 
sia. It may be remarked, by the way, that much 
of the sleeplessness attributed to the after-din- 
ner coffee may legitimately be laid to the dinner 
which preceded the coffee. 

Cases of insomnia that are caused by drug 
addiction, such as opium or cocaine, are partic- 
ularly obstinate and require the most rigorous 
kind of treatment. They are as difficult to con- 
quer as the insomnia presaging and accompany- 
ing mental diseases. 

The occurrence of insomnia signifies that the 
mental, emotional or somatic machinery is out 



22 SLEEP AND THE SLEEPLESS 

of order. Before it will run well again tlie 
cause of the disorder must be found and over- 
come. 

Sleep is an endowment, like cliarm or a good 
disposition. It can be added to by cultivation 
and effort or it can be shattered. Originally it 
may have been meted out alike to the rich and 
the poor, but in the present stage of evolution 
there would seem to be much discrimination. 
It is a fact that insomnia is much rarer amongst 
the poor than amongst the wealthy and it is re- 
markable how seldom complaint of insomnia is 
heard from the lower class of hospital patients. 
The explanation possibly is that insomnia fre- 
quently flows out of overfeeding, idleness, self- 
absorption and ennui, and the labouring poor 
are not beset by any of these ills. It may be that 
they regard sleeplessness as a minor ailment 
and do not mention it, but it is more likely that 
they are less subject to many causes of sleepless- 
ness than their envied brothers. 



CHAPTEE m 

THEOEIES AND PHENOMENA OF SLEEP 

The problem that confronts the victim of iq- 
somnia is to determine why he does not sleep 
soundly, adequately or refreshingly. To do this 
he should know the significance of sleep and 
something of its theories. 

There has been a vast amount of study and 
experimentation by physicians and psycholo- 
gists to discover the so-called cause of sleep. 
As to its virtue there can be no discussion. ' ' To 
sleep," wrote Amiel, ''is to strain and purify 
our emotions, to deposit the mud of life, to calm 
the fever of the soul, to return into the bosom 
of maternal nature, thence to reissue, healed and 
strong. Sleep is a sort of innocence and purifi- 
cation. Blessed be he who gave it to the poor 
sons of man as the sure and faithful companion 
of life, our daily healer and consoler." 

The human being asleep, is in a state of total 
23 



24 SLEEP AND THE SLEEPLESS 

unconsciousness. All cognizance of personality 
and action and, for the most part, man's sense 
and ideas cease to exist. It is not possible to 
decide to what extent this abnegation of the 
conscious life, these intimations of oblivion, are 
merely a seeming and a forgetting. The chance 
recall of dreams warns us of the possible ex- 
istence of mental phenomena during the sleep- 
ing state which, under ordinary circumstances 
of life, do not connect themselves with the con- 
scious memory. 

Theories of Sleep. — The nature and cause of 
sleep are still a mystery. Many theories as to 
the underlying causes of sleep, that is, of the 
physical and chemical changes that occur in the 
brain and other parts of the body during sleep, 
have been propounded. 

The first theory. The most generally ac- 
cepted one is that sleep is accompanied by a 
diminution in volume and velocity of the blood 
in the brain, and that this is the physical basis 
of sleep. This theory makes sleep aldn to the 
unconsciousness which attends what is popu- 
larly called fainting. Those who attempt to ex- 
plain sleep in this fashion claim that insomnia 



PHENOMENA OF SLEEP 25 

is the expression of the opposite state, namely 
an excess of blood in the brain, an exaggerated 
blood pressure and increased velocity. 

The second theory. A more recent theory is 
that the physical basis of sleep is a certain phys- 
ical alteration in particular prolongations of 
the cells or units of which the brain is largely 
constructed. Each nerve cell has a number of 
processes which jut out from its side like the 
feet of a centipede. These are called ''den- 
drites." These processes come in contact with 
those of other cells and in this way form a con- 
tinuous link. When they are thus continuous, 
the current (of whatever nature it is), that is 
necessary to consciousness flows through har- 
moniously. When the contact is broken the 
current ceases to flow and the result is sleep. 
Consciousness is unquestionably due to a certain 
state of the nerve cells and any departure from 
complete consciousness must be due to some 
change in this condition. It is probable that 
this state and its alterations are of a chemical 
nature. 

The third theory. The chemical theory of 
sleep is one which has a wide acceptance 



26 SLEEP AND THE SLEEPLESS 

amongst tliose who have studied the subject. 
It is based upon the hypothesis that during the 
waking hours there is developed, and to some 
measure accumulated within the system, by- 
products of the system's activities, and that 
these, soporific in their effect, produce a sensa- 
tion of tranquillity, drowsiness and sleep. When 
sleep occurs, the tissues concerned in producing 
poisonous products cease their activity. The 
substances which were produced and which 
acted as soporific are thrown oif during the 
night and when they are all eliminated the cells 
are ready to start in fresh. Then the cycle is 
repeated. 

These theories testify to man's ingenuity. 
There is no doubt whatsoever that cellular ac- 
tivity, whether it be muscle cells, gland cells or 
brain cells, is accompanied by formation of 
products which, if retained in the system, are 
poisonous, but it is difficult to see the justifica- 
tion for contending that this is the cause of 
sleep. 

The fourth theory. The interpretation of 
sleep as one of the essential phenomena of life 
has recently been elaborated into a theory which 



PHENOMENA OF SLEEP 27 

is called the biological theory. Claparede con- 
tends that sleep is a phenomenon of nature in 
the shape of a reaction of defence to protect the 
organisation against fatigue. Sleep is an in- 
stinct, and we sleep not because we are ex- 
hausted, but because we cannot help it. Like 
every instinct it is a manifestation of evolution- 
ary development. It did not exist at all times 
and it is not in any way an essential phenom- 
enon of life. If sleep has developed, it is prob- 
ably due to the fact that those animals whose 
activity was broken by periods of repose or im- 
mobility have been favoured in the struggle for 
existence, for they have been enabled, owing to 
an accumulation of energy during these periods, 
to manifest, in consequence, a more intense ac- 
tivity. As to these periods of immobility, they 
are themselves derived from the function of ces- 
sation of defence which plays such a great role 
in the animal kingdom. 

Unquestionably the position taken by Clapa- 
rede will be acceptable to scientists. It harmo- 
nises with what the physiologist and psycholo- 
gist know about sleep and its physical basis. 

Sleep is a resting state of consciousness 



28 SLEEP AND THE SLEEPLESS 

which is facilitated, and, if one likes to affirm it, 
caused, by cessation or interruption of all those 
stimuli that come from without, and which 
reach the human organisation principally 
through the special senses. 

Phenomena of Sleep. — The velocity of the cir- 
culation, and of the respiration is diminished 
during sleep. The pulse of sleeping indi\dd- 
uals is slow and full as compared to that of the 
waking state. Breathing is more deliberate, 
sometimes laboured. Digestion and absorption 
may take their course with unabated vigour, but 
the blood supply of the brain and the organs un- 
der voluntary control is diminished. The tem- 
perature of the body is lowered during sleep. 
And all the secretions, except that of the skin, 
are lessened. The urine, saliva, the secretions 
from the mucous membranes are all less abun- 
dant in sleep than in waking. Perspiration, 
however, is frequently increased instead of di- 
minished, not only as a result of relaxation of 
the vessels in sleep, but particularly from the 
custom, which is almost universal, of covering 
the body with layers of clothing that prevent 
radiation of bodily heat. 



PHENOMENA OF SLEEP 29 

Most of the so-called reflexes are diminished 
or abolished. The fact that not all the reflexes 
are abohshed is shown by the existence of res- 
piration and heart pulsation. There are other 
reflexes which are neither diminished or ar- 
rested during sleep, for instance, those guarding 
the chief elemental portals of the body. No gen- 
eral statement can be made as to which are abol- 
ished, because a considerable difference obtains, 
in this respect, between the various species, and 
even between individuals of the same species. 

That there are different degrees of sleep goes 
without saying. We constantly hear persons 
speak of deep, light sleep, and broken sleep. 
Besides there is every gradation between com- 
plete wakefulness and profound sleep. Sleep 
may vary in intensity or depth from a semi- 
conscious state in which complete ideas and 
sensations may subsequently be recalled either 
in whole or in part, to an absolute dreamless 
state. This temporary abeyance of conscious- 
ness, whether complete or partial, is without 
doubt associated with cessation of the acquired 
functions of the brain. It is perhaps safe to 
say that the progression, from light to deep 



30 SLEEP AND THE SLEEPLESS 

sleep marks a gradual diminution of the func- 
tions of the brain. 

One cannot say that there is absolute cessa- 
tion of the functions of the brain during sleep, 
although there seems to be. It has frequently- 
been alleged that mathematical problems have 
been solved during sleep, that poetry and music 
have been composed, but in reality what has 
happened is that the whole body, having been 
rested during sleep (the whole body with which 
we think), takes up the problem with which 
it had previously been concerned and finishes it 
satisfactorily. 

Increasing depth of sleep is marked by the 
same progressive diminution of many or of all 
the functions of the body. The closer the func- 
tions are associated with consciousness and 
especially with the will of the individual, the 
more completely are the functions suppressed. 
Depth of sleep is therefore not only propor- 
tioned to the abeyance of consciousness but also 
the depression of all bodily functions. The 
state of sleeplessness or insomnia may there- 
fore be indicated as an approach to the normal 
waking, physical and mental condition. The 



PHENOMENA OF SLEEP 31 

main distressing feature of insomnia is the per- 
sistent continuance of mental activity in some 
form. 

Whatever may be our explanation of sleep, it 
is certain that we cannot do without it. Patients 
oftentimes tell us that they have not slept a wink 
all night, but we may be sure that such a state 
of wakefulness cannot be maintained for more 
than a night or two. 

Tales of extraordinary capacity for going 
without sleep excite a ready interest, and the 
public reads with avidity the records of great 
and famous personages regarding a matter in 
which all participate, and about which every- 
one has something peculiar to relate. 

It is said that John Wesley found that five 
hours ' sleep sufficed him, but he was often seen 
asleep whilst riding on his horse. It may have 
been with him as with many others ; little naps 
in the day are overlooked in the calculation of 
the sleep obtained at night. A momentary sleep 
often suffices to produce the rest that is needed. 

It is generally believed that one-third of our 
existence should be spent in sleep, but this is no 
more true than that the preservation of health 



32 SLEEP AND THE SLEEPLESS 

requires us to partake of food three times a day 
or to drink three pints of water in twenty-four 
hours. 

Insomnia is a relative term. The amount of 
sleep that suffices for one individual would be 
in another productive of misery and a disorder 
of nutrition which might lead to disease. Sleep 
is measured by its depth as well as by its dura- 
tion, and it is as difficult to express in minutes or 
in hours the requisite quantity of sleep for the 
normal human being, as it is to state the proper 
degree of depth of sleep. Experience teaches 
that the deeper the sleep, in other words, the 
more profound the cessation of mental and bod- 
ily functions, the less protracted need that sleep 
be in order that the individual may receive phys- 
ical and mental restoration and refreshment. 

Sleep may indeed be indulged in to excess. 
Too much sleep produces lassitude and debases 
and stupefies the mind. Carried to extreme it 
is as much an act of intemperance as excessive 
drinking and eating. 

As to the time when sleep should be taken, 
night is of course preferable since it is the time 
when the sleeper is least likely to be disturbed 



PHENOMENA OF SLEEP 33 

by stimuli coming from without, such as light 
and noise. There is no evidence, however, to 
show that, were light and noise controllable, 
sleep obtained during the day would be less 
beneficial than sleep obtained at night. 



CHAPTEE IV 

INSOMNIA DUE TO PHYSICAL CAUSES 

Bepoee attempting to instruct the sleepless as 
to the method and manner of overcoming in- 
somnia the form and character of the evil from 
which they suffer must be ascertained. 

Insomnia not a Disease. — Insomnia is a 
symptom, not a disease. It is a derivative, a 
by-product, the effect of definite causes, which 
must first be removed before any progress can 
be reasonably expected in the work of regain- 
ing sleep. For the purpose of determining the 
proper treatment to be adopted, it may be well 
to divide insomnia broadly into two distinct 
classes. First, insomnia springing from purely 
physical causes. Second, insomnia derived 
from mental, moral or emotional causes. 

The first has its origin in physical pain or 
discomfort. It may be a mashed thumb, rheu- 
matism, cold feet, indigestion, influenza or the 
35 



36 SLEEP AND THE SLEEPLESS 

toothache. Generally the treatment here is sim- 
ple. Eemove the cause and the effect will dis- 
appear. Ease the aching tooth and sleep will 
come. 

The other insomnia is bom from grief, cares, 
expectations, anxieties, great business, and all 
violent perturbations of the mind. It may be 
due to anything that exalts, excites and makes 
unaccustomed appeal to the special senses. 
This is the most persistent variety. Not in- 
frequently it is the initial symptom of many 
mental diseases. 

Insomnia derived from this disordered mental 
condition is prone to engender in the mind of 
the sufferer the fear of approaching insanity. 
*'I am sure I shall go mad," is a frequent state- 
ment from insomniacs of this character. For- 
tunately this fear is groundless. Sleeplessness 
does not cause insanity. The victim may be- 
come depressed, irritable, excitable, inattentive, 
but his senses will not forsake him. I have 
seen so much suffering result from ignorance of 
this fact that I purposely emphasise it here. 
Fear of disease is sometimes worse than the dis- 
ease itself and the suffering incidental to such 



PHYSICAL CAUSES 37 

fear cannot be measured. The unhappy and 
unfortunate victim of insomnia has enough to 
contend with. Let him banish forever the fear 
that the integrity of his mind is threatened. 

Before taking up the detailed analysis of 
mental insomnia, let us consider the less com- 
plex form of physical insomnia. 

"Physical" Insomnia. — Grouped under this 
head are many passing discomforts which, from 
the fact that they occasion only temporary 
sleeplessness, only enter incidentally into a study 
of insomnia. A slight irritation of the throat 
accompanied by an annoying tickling sensation 
of the larynx is quite sufficient to keep the emo- 
tional human being awake. Trivial matters 
such as chilblains or an itching skin disturb sleep 
as effectively as rheumatism or indigestion. 
Where spraying the throat or anointing the in- 
jSamed epidermis with some oleaginous salve 
will readily effect a cure of the minor ailments 
cited; however, in the case of indigestion or 
rheumatism the matter is not so simple. 

Indigestion is of many kinds and varieties. 
We speak of stomachic indigestion and intesti- 
nal indigestion, of in(^igestion due to perversion 



38 SLEEP AND THE SLEEPLESS 

of the digestive juices, to disturbances of motil- 
ity of the digestive tract, to the formation of 
such deleterious processes as fermentation, to 
a disturbed nerve supply of the digestive or- 
gans, etc. It is unnecessary to consider the dif- 
ferent forms here in order to discuss the 
treatment of insomnia which results from indi- 
gestion, except to say that success can attend our 
efforts only when the underlying cause of in- 
somnia, namely, the indigestion, is sought, de- 
tected and successfully combated. Of all the 
varieties of indigestion which cause disturbed 
sleep those which are attended with fermenta- 
tion, especially when this provokes flatulency 
and pain, are the most important. In making 
this statement it is realised that one of the most 
obstinate forms of insomnia to overcome is the 
variety dependent upon disturbance of circula- 
tion, such as arteriosclerosis which in turn is 
dependent upon chronic indigestion and fermen- 
tative processes in the intestines. 

The \dctim of indigestion who does not put 
himself in the hands of a physician who will de- 
termine the underlying cause, is not giving him- 
self a fair chance. Much is heard nowadays of 



PHYSICAL CAUSES 39 

the necessity of popular lectures to familiarise 
the average intelligent laity with the findings of 
science. I know of no field that would yield a 
more favourable or beneficial crop of informa- 
tion than the plain and truthful setting forth of 
the fact that medicines are practically of little or 
no use in the treatment of chronic diseases or 
any other diseases, save temporary functional 
provisions of the different organs of the body. 

Unless one happens to be a member of a drug- 
taking family, or a physician, and especially a 
hospital physician, it is almost impossible to 
realise the bondage in which drugs hold many of 
our fellow beings. The indiscriminate taking of 
drugs apparently has no relationship to intelli- 
gence and common sense. Men and women 
whose daily life and work testify to their equa- 
nimity, their good sense and sound judgment, 
pour drugs into themselves for the relief of this 
or that minor ailment, in a way that transcends 
all understanding. And for no disturbance of 
functions are drugs taken so indiscriminately as 
for disorder of the digestion. 

The amount of money spent on pepsin, pan- 
creatin, takadiastase, charcoal and so-called in- 



40 SLEEP AND THE SLEEPLESS 

testinal disinfectants in this country could es- 
tablish a fund, which, if wisely used for popular 
education, would in one generation do more to 
overcome indigestion than all the drugs in the 
world. To many it will come as a decided shock 
that there is scarcely a particle of evidence to 
show that any of the substances enumerated 
above are of any value. The most elaborate in- 
vestigations made on intestinal fermentation to 
demonstrate the value of so-called intestinal an- 
tiseptics have shown conclusively that the only 
drugs which have any effect in diminishing fer- 
mentative processes in the intestines are those 
which stimulate the action of the intestines to 
remove the offending substance from the 
body. 

One of the common manifestations of such 
indigestion is flatulency. Flatulency, which 
seems to be the immediate provoker of sleep- 
lessness, often produces its worst effects, when 
we are not conscious of its existence, by eructa- 
tion or expulsion of gas. Wlien we suffer from 
flatulency in the ordinary sense, we are con- 
scious of the desire to get rid of, or disperse, the 
gas. When it is tolerated by the stomach this 



PHYSICAL CAUSES 41 

gas produces an oppressive pain around the 
heart. 

Of the many expedients that may be util- 
ised for the treatment of sleeplessness due to 
flatulence, the simplest is a glass of hot water at 
bedtime and it is usually effectual. Its effici- 
ency may sometimes be enhanced by the addi- 
tion of a simple aromatic, such as a few drops of 
spirits of peppermint or aromatic spirits of 
ammonia. It should be taken a half hour be- 
fore going to bed, as the movements of undress- 
ing facilitate the expulsion of gas from the 
stomach either by eructation or by sweeping it 
into small intestines where contact with the bile, 
which is antiseptic, prevents further fermenta- 
tion. If this simple remedy is not adequate, 
the administration of a teaspoonful of com- 
pound tincture of cardamom may be added. 

Dry heat to the pit of the stomach, such as a 
hot water bag or a hot plate, or vigorous fric- 
tion and manipulation of the abdomen, is some- 
times very serviceable. In cases of flatulency 
that are rebellious to these simple measures, it 
is essential that the contents of the stomach be 
taken and analysed in order that the cause of 



42 SLEEP AND THE SLEEPLESS 

fermentation be determined. It is in such 
cases that washing out of the stomach is often- 
times of signal service. 

There are many conditions of circulation that 
cause insomnia. Among these, cold feet is the 
most important. It is, I fancy, the commonest 
immediate cause of insomnia. Itself a symp- 
tom of disordered digestion, constipation, anae- 
mia or other disease, it stands Cerberus-like 
between the disorder and Nature's restorer. 
The condition of which it is the expression may 
have to be thwarted before it is overcome. 

Much can be done to counteract its effect by 
a few simple measures, such as holding the feet 
for a few seconds alternately under a stream of 
hot and cold water, then frictioning the feet and 
legs vigorously and enveloping them in warm 
flannel up to and above the knees. It is in- 
credible how much difficulty has been encoun- 
tered in getting this simple and frequently ef- 
ficacious measure carried out. It is too much 
trouble for the majority of those to whom 
it is recommended. A hot water bottle is so 
much easier though it is much less useful. It 
may be that the languor and weakness which 



PHYSICAL CAUSES 43 

such persons display are but a part of the gen- 
eral sluggishness of circulation indicated by the 
coldness of the extremities. 

Coldness of the feet is apparently the cause 
of sleeplessness in many brain-workers who are 
free from ansemia and poor circulation of blood. 
It is not a negative coldness which can be over- 
come by external warmth. It has to be righted 
through the general circulation. It is in such 
cases that a hot, mildly stimulating drink such 
as hot milk, cocoa or beef extract, on retiring is 
most beneficial. Such a procedure is partic- 
ularly potent in overcoming insomnia if the feet 
are thrust into cold water and vigorously rubbed 
for a few minutes. 

Sleeplessness due to burning sensation in the 
feet is a more stubborn cause of dysomnia than 
cold feet, for when it occurs in its most exag- 
gerated form it is an indication of some graver 
disorder than cold feet. The treatment of it is 
the treatment of the underlying cause. 

Insomnia associated with, or dependent upon, 
structural disease of the blood vessels known as 
arteriosclerosis is often most rebellious to treat- 
ment. In every case of such arterial disease 



44 SLEEP AND THE SLEEPLESS 

it is essential that the blood pressure or arte- 
rial tension shall be determined, and this can 
be done only by the physician. It is a well- 
established fact that high blood pressure and in- 
somnia often go together. There again it is es- 
sential to search for and counteract or remove 
the cause of the arterial tension. In the major- 
ity of instances this is some form of intoxication 
arising within the system or the expression of 
such disorder of metabolism as gout or diabetes, 
any of which calls for the most rigid dietetic 
treatment. Indigestion in one form or another, 
but particularly fermentative intestinal indiges- 
tion, is the common forerunner of these condi- 
tions, and I shall refer to the treatment of it 
when discussing the relationship of dyspepsia 
to insomnia. 

The insomnia of arteriosclerosis is often suc- 
cessfully combated temporarily by instructing 
the patient to take a small amount of stimulant 
such as whisky and hot water or milk before re- 
tiring and repeat this early in the morning. 

While the insomnia that springs from physi- 
cal pain or discomfort is easier to eradicate than 
that which originates from mental or emotional 



PHYSICAL CAUSES 45 

causes, it frequently happens that through fail- 
ure to combat the ailment in its milder manifes- 
tation, what was at first but a physical reflex 
becomes mental also. The principle "Mens 
Sana in corpore sano" applies to nothing so 
aptly as to insomnia. If the body be healthy 
the mind will be sound. It is when the body is 
driven from day to day in a condition half way 
between sickness and health with perhaps a dis- 
abled kidney or liver insidiously sapping away 
life's elixir, that the foundation is laid for one 
of the most persistent forms of insomnia. 

The patient will not ascribe his inability to 
sleep to malnutrition or to poor circulation, 
and since his mind is free from mental anxiety 
eoncerning the stock market or his wife's co- 
quettishness, he will be at a loss to explain his 
sleeplessness to himself. At this point he will 
be likely to take quick alarm at his condition and 
to jump at the conclusion that his inability to 
sleep is a disease in itself and not merely a 
symptom. He will become panic-stricken at the 
apparently inexplainable, and instead of har- 
bouring the constructive thought of sleep will 
fasten and brood upon the destructive thought 
of insomnia. 



CHAPTER V 

INSOMNIA FEOM MENTAL CAUSES 

The normal human being is born with the de- 
sire and the intention to spend a considerable 
portion of his time in sleep. Whether he works 
or plays he will still expect to add a period of 
oblivion to all things that make a direct appeal 
to his senses. He may exercise np to a certain 
point his power of choice to postpone or rednce 
this period of oblivion but he will always pay 
the full price for doing so in loss of comfort and 
efficiency during the waking period thus unwar- 
rantably lengthened. 

The law of sleep is the law of life. Failure 
to observe it must inevitably result in physical 
bankruptcy. Anyone who sets aside his inten- 
tion and desire to sleep will find in the long run 
that he has set aside to some degree his desire 
and intention to live. 

"Mental" Insomnia. — In the majority of 
cases in which insomnia is directly traceable to 
47 



48 SLEEP AND THE SLEEPLESS 

absence of mental tranquillity, it will be found 
that in the earlier stages tbe wakefulness was de- 
liberate and intentional. The individual who 
goes to bed with the will to remain awake will 
readily achieve his purpose if he continue to 
feed thoughts to his brain. It may be that in a 
few hours before retiring he has been under 
some violent mental excitement. He may have 
attended some important public function where 
his eloquence has won him applause. He may 
have taken part in some heated altercation over 
politics or cards. He may have been emotion- 
ally stirred by some slight, real or fancied, ad- 
ministered by one dear to him. Business may 
have been suddenly upset or perhaps is simply 
in danger of being upset. Stocks may be going 
up — or down. 

In any of these contingencies, and a thousand 
others, sleep will be deliberately and intention- 
ally banished. The mind will be kept active 
from choice, reviewing the social triumph 
achieved a few hours earlier or recalling this or 
that unpleasant epithet hurled in an angr^^ mo- 
ment. Whether it be the young debutante 
dancing over her dances in retrospect or the 



MENTAL CAUSES 49 

man of business following the details of an in- 
tricate deal soon to be consummated, minutes, 
even hours, elapse before lie or she will even 
register the thought ''Better leave all this and 
go to sleep. ' ' 

If the mental excitement has been natural and 
reasonably moderate, the individual may pass 
into unconsciousness with this imposition of the 
will to sleep, even though long delayed. If, 
however, the mental excitement has been un- 
usual or of great intensity, it frequently happens 
that by the time the individual records this in- 
tention and desire to sleep, the brain which he 
has goaded and spurred into a feverish gallop 
refuses to stop. The mind refuses to obey and 
the same thoughts, at first summoned with de- 
liberate intent, return as unbidden guests and 
defy every effort made to dislodge them. 

If the incident giving rise to this uncontrol- 
able effervescence of mind is of momentary du- 
ration only, that is, if it is of a character to be 
easily dismissed on the morrow because of its 
having been concluded and ended, then the vic- 
tim wiU have been at a loss of just one night's 
sleep. But if the cause of the mental perturba- 



50 SLEEP AND THE SLEEPLESS 

tion is a continuing cause, if, let us say, the stock 
market is still moving contrary to the desire 
and interests of the casual insomniac of the 
night before, then there is danger of a second 
night being spent as fruitlessly as the first. 
His condition will become aggravated from the 
fact that his thoughts by losing nothing in in- 
sistency will lose in meaning and significance. 
While active enough to keep him awake, they 
will cease to interest or engross him. He will 
think mechanically and uncomprehendingly. 
The same thought will obtrude itself again and 
again. He will be drowned in it, made deaf by 
it. The buzzing of a mosquito, heeded for a 
period of ten seconds, may be found to have 
some element of melody to it, but continued for 
hours it irritates to the point of frenzy. In the 
same way the tenacity of that single meaning- 
less idea, throbbing away unceasingly in his 
brain, will develop into bodily irritation and loss 
of temper. This will result in hurried heart 
action and heightened temperature and carry 
the victim into another wakeful day, tired, nerv- 
ous and ill-natured. 
It is perhaps at this stage that his greatest 



MENTAL CAUSES 51 

danger will confront him — the FEAR of in- 
somnia. 

When those who have been a prey to the sleep- 
dispelling mental obsessions described, approach 
the hour for going to bed, not only fearful that 
they may not sleep, but with a firm conviction 
that they will not sleep, their condition may be 
viewed with alarm. Such an attitude is nega- 
tive and very naturally conducive to sleepless- 
ness. 

The insomniac who repeats to himself that he 
will not sleep is adding momentum to his descent 
into the lowest pit of sleeplessness with every 
repetition of the thought. Just as it only re- 
quires so many reiterated declarations of "I 
will sleep" in order to bring on slumber, so will 
it only require a certain number of repetitions 
of " I will not sleep ' ' in order to bring on wake- 
fulness. And the longer this negative thought 
is harboured, the harder will it be to dislodge it. 

It is vital that insomniacs of this character 
cultivate and acquire the right point of view. 
They must learn to view their infirmity in the 
right perspective. To be sure, a little insomnia 
disturbs the aspect of the whole world and it 



52 SLEEP AND THE SLEEPLESS 

early becomes impossible for the victim of it 
to take an impersonal view of bis disability. 
He dreads the advent of the night as the wed- 
ding guests dreaded the coming of the An- 
cient Mariner. He sees in anticipation a repe- 
tition of past performances from which he 
emerged dismayed, desolate and despairing. 
He is convinced that he will not sleep and 
frequently he needs more than verbal as- 
surance to have this conviction dislodged. 
The victim of this sort of wakefulness must help 
to overcome his difiQculty by cultivating a will to 
sleep. All deliberate tasks of the will are irk- 
some and it is easier to follow along the line of 
compelling natural desires. But the construc- 
tive point of view to be acquired in combating 
insomnia is that sleep is a compelling natural 
desire. The will to stay awake is easier than the 
will to sleep, because the incentive to the former 
is very keen at the time when it is first essayed. 
But in the normal man, the will to remain awake 
is short-lived. It is short-lived from the point 
of view of comfort and not very long-lived from 
the point of view of safety. 

The insomniac should be encouraged by the 



MENTAL CAUSES 53 

realisation of the fact that the distribution of 
sleep and "wakefulness is a process which goes on 
according to natural law and is not wholly, per- 
haps very little, subject to immediate direction 
of the human will. The natural law is to sleep 
and the will to obey this law is the natural will. 
When, therefore, we seek to persuade the suf- 
ferer from wakefulness to cultivate a will to 
sleep, to develop a method where before he had 
been playing a speculative game, we are, in fact, 
simply asking him to conform to a natural law. 

If the insomniac should feel confused before 
the question of what will is, we can say to him, 
''Put the whole matter on the ground of desire. 
Imbue yourself with the idea that what a man 
most ardently desires, that will he get, and re- 
member that man's most ardent desire is as 
nothing compared with Nature's desire." 

When Nature desires that we should sleep, 
it is no light and trivial whim that may be 
waived lightly aside, but a formal and definite 
command, transgressed at heavy cost. We 
cannot bargain over this matter. We cannot 
modify Nature's age-long will that we should 
sleep by offering her tithes from the fruits of 



54 SLEEP AND THE SLEEPLESS 

forced wakefulness. Sleep is tlie method by 
wbicli we obtain wakefulness. It is the thing 
first to be desired because through it alone 
comes wakefulness. It is to be desired not in 
some wilful, fitful, coquettish way, but in Na- 
ture's way: imperiously, systematically and 
without abatement. The law of sleep towers 
above man's activities as high as the laws of 
Nature raise themselves above the rules of men. 
Nature 's method is not that of extended wake- 
fulness but of systematised distribution of wak- 
ing and sleeping, profoundly restful sleep on 
the one hand and systematised expenditure of 
efficient efforts during wakefulness on the other. 
When this systematic allotment has been funda- 
mentally disturbed, the unfortunate individual 
is face to face with a condition from which he 
ought to be willing to seek deliverance at any 
cost. He is the victim of misplaced confidence, 
a relic of misdirected endeavour. Once on a 
time he knew what sleep was — oblivion, an un- 
charted country, known only in terms of its 
borderlands. Like most people who know too 
much about the unknown, he now suffers 
through the possession of a new and particular 



MENTAL CAUSES 55 

kind of knowledge. Pie knows at heavy ex- 
pense to himself a state that is neither good 
sleeping nor good waking, a state negative of 
all good results, for which there is the especially 
coined word INSOMNIA. Its special charac- 
teristic may be defined as the absence or nega- 
tion of that degree of sleep which we find to be 
grateful and at the same time necessary for the 
formation of successful and happy living. It is 
a strange form of being awake, toward which 
we are most bitterly antagonistic. No light of 
happy sentiment plays about it. It is shrouded 
in the darkness of lost desire and only one clear 
ray of understanding sweeps across its gloom: 
''Sleep is gone, sleep has not come." All this 
the insomniac feels and says to himself more or 
less clearly. But it is necessary if he would 
abandon the undesired freedom which wakeful- 
ness brings him and deliver himself bound with 
the chains of the good tyrant SLEEP, for him 
to get out of the region of sentiment and feel- 
ing and into the region of Will and Endeavour. 
He must make friends and become partner of 
the indispensable state of Sleep. He must fol- 
low the dictates of common sense and common 



56 SLEEP AND THE SLEEPLESS ] 



experience toward a state which brings him to ^ 

his liveliest sense of power and his deepest J 

sense of well-being. He must make it one of i 

his routine and unqualified affirmations that he i 

wants sleep of the sort and amount that will ; 

make him most efficiently active in those hours j 

when it goes away, and which leave him to the ' 

great business of living properly and happily. < 

He must cease his useless endeavour to think ' 

about insomnia, to solve its mysteries, to \ 

measure its dangers, and to mitigate its dis- | 

comforts. It is towards Sleep that he must j 

turn his attention. To solve its secrets should ' 

be his endeavour. To be able to turn the key . 

which opens its doors or at least to hide the : 

key with which either his friend or his enemy , 

would shut the door against him and bar him j 
out, should be his highest aspiration. 



CHAPTER VI 

DREAMS 

Among the most common disturbances of sleep 
are dreams. This subconscious state is typ- 
ical of the lighter stages of sleep, and in the vast 
majority of instances occurs just before waMng 
and after sleep is complete or practically so. 
Because of this, the disturbance occasioned is 
not serious and generally plays only a small 
role in the causation of insomnia. 

Though dreams may not disturb sleep mate- 
rially, their effect upon the sleeper, particu- 
larly if he retain the memory of them, can have 
serious consequences. Dreams that shock and 
which return with persistence into the memory 
of the patient may give rise to tenacious obses- 
sion and so disquiet the mind during the wake- 
ful period as to act as a barrier to sleep. Most 
dreamers, however, give up the memory of their 
dream immediately upon waking and go through 
the ever}"-day routine none the worse for hav- 
57 



58 SLEEP AND THE SLEEPLESS 

ing had tliem. The relationship between 
dreams and sound sleep is a very close one. 
Since time immemorial, dreams have given rise 
to the exercise of much ingenuity in their inter- 
pretation. The significance which Joseph put 
upon those related to his brethren is an elemen- 
tary lesson 'in symbolism compared to the in- 
terpretations put upon them by a modem son 
of Israel, of Vienna. According to Freud, 
a dream consists merely of the dreamer's dis- 
turbed waking experiences, whether these be 
sujDpressed painful memories of the waking 
life or whether they be experiences of which 
the individual is not aware because he has not 
made conscious note of it. 

Sleep disturbances have their origin in our 
waking experiences and although we are not 
able to trace the origin of a particular dream, 
it is because we are not able to ferret out the 
dormant memories of subconscious episodes of 
long ago. No matter how distorted or fantastic 
dreams may seem, they are memories of pre- 
vious experiences. Oftentimes these experi- 
ences are the property only of what is known 
as the subconscious mental life. In sleep the 



DEEAMS 59 

censorsliip of waking consciousness is removed 
and then suppressed or disassociated experi- 
ences stalk forth and occupy the stage. Freud 
traces the origin of most of the functional nerv- 
ous diseases by the pursuit of clues furnished 
only by dreams. 

During the last few years much attention has 
been paid to dreams, and there are those who 
contend that the information to be obtained 
from their study furnishes the key to the door 
which heretofore has guarded the secrets of the 
causation and existence of many states of ill- 
health variously called hysteria, obsession and 
chronic ill-health. 

From the beginning of history dreams have 
been considered of portentous importance in 
giving information of future events. The pres- 
ent-day view is that they may be made to yield 
information concerning past events which the 
dreamer hides in his conscious state. There^ 
are those who maintain that there is no such 
thing as dreamless sleep. A recent writer on 
the subject, Sir Arthur Mitchell, while advanc- 
ing this view, admits that it may be disputed. 
In the face of much testimony of many persons 



60 SLEEP AND THE SLEEPLESS 

who maintain that they do not recall ever having 
dreamed it is hard to establish a proof. But 
those who maintain that there is no such thing 
as dreamless sleep hold to their opinion on the 
basis that those who offer their experiences 
in opposition to this view actually do dream but 
do not remember it. 

If we are asked to believe that we may dream 
and not be conscious of it, it becomes very dif- 
ficult for anyone to state that there is no sleep 
without dreaming. This is on a par with the 
Christian Scientists who say "He is not dead'* 
but whose family or friends go ahead and bury 
him as though he were dead. So far as the in- 
dividual impersonating the corpse is concerned, 
it does not really matter. 

Dreams and Sleeplessness. — The psycholog- 
ical question of whether or not the mind con- 
tinues to be operative during sleep is what 
really concerns physicians and scientists. Do 
dreams disturb sleep? Do they take from its 
capacity for refreshment? The answer is, that 
it depends upon both the dreamer and the 
dream. If the dream picture some horror or 
distress, either physical or mental, it is obvious 



DREAMS 61 

that the dreamer will be anything but soothed 
thereby. If the dreamer be of a nervous tem- 
perament, the fictitious tragedy in which he will 
have played a part in his sleep will leave him 
troubled and unrefreshed. Just as there are 
dreams that terrify because of their nature and 
shock because of their immorality, there are oth- 
ers that comfort and restore. 

In Locke's Essay on Human Understanding 
is found a sentence, '' The dreams of sleeping 
men are all made up of waking men's ideas, 
though for the most part oddly put together." 
But considering the fact that morals and ethics 
are frequently entirely lacking in the dreams 
of the best and most refined, this can scarcely 
be accepted at the present day. It would shock 
us to know of the improper things which the 
most proper people do and think with unblush- 
,ing effrontery in dreams. Passions which 
never for a moment visit our conscious mo- 
ments, sentiments the very opposite of those 
belonging to our idiosyncrasies present them- 
selves in sleep and are followed by their appro- 
priate actions just as if we were then not our- 
selves at all. We commit the most ruthless 



62 SLEEP AND THE SLEEPLESS 

crimes without compunction or the smallest 
feeling of sorrow which in our waking hours 
would cause us unmitigated grief and remorse. 
Maudsley has said that if we were held respon- 
sible for what we do in our dreams there is no 
man living who would not deserve to be hung. 

It has been proven by those who have studied 
dreams and their incidents that in a few min- 
utes sleep a dream of such intricacy and in- 
volving such a variety of incidents has taken 
place that if it were to be acted out in reality 
months and years would be necessary. 

Those who are distressed by having their 
sleep visited night after night by fantastic vi- 
sions and nerve-shattering dream tragedies 
should bend all their efforts to the converting 
of their light and shallow slumber into sound 
and heavy sleep. The sounder the sleep, the 
less the opportunity for dreams. By purging 
our thoughts as much as we can of memories of 
a violent character, and closing our mind to all 
constructive or speculative thought we may be 
able to shut out a nightmare. Let the dreamer 
take comfort, however, in the thought that even 
though his dreams persist they occupy but a 



DREAMS 63 

few minutes of the hours spent in sleep and 
that his period of unrest is comparatively in- 
consequential and altogether insufficient to rob 
the period of rest of its restorative value. 



•i 



CHAPTEE VII 

THE EEQUISITE QUANTITY OF SLEEP 

No BELIEF is more deeply rooted than that the 
average individual requires seven, eight or more 
hours of sleep. Like most firmly established 
popular conceptions, it is entirely unjustified. 
History abounds with examples of men whose 
existence was contemporaneous with some 
epochal transformation and who contributed im- 
measurably to the pleasures of life, who were 
able to do their work on half that amount of 
sleep. That it is possible to do intellectual work 
of the first order and to maintain a degree of 
vitality enabling its possessor to live out the 
scriptural allotment is evidenced by Herbert 
Spencer. ''Appearances gave the impression 
that I was in fair health," he tells us in his 
autobiography. "Appetite and digestion were 
both good, and my bodily strength, seemingly 
not less than it had been, as tested by walking, 
65 



66 SLEEP AND THE SLEEPLESS 

was equal to that of most men who lead town 
lives. This continued to be my state for many 
years. Both then and afterwards, my sleeping 
remained quite abnormal. A night of sound 
sleep was and has ever continued to be unknown 
to me : my best nights being such as would com- 
monly be called bad ones save when leading a 
rural life with working and out door sports to 
occupy attention. It probably averaged be- 
tween four and five hours of unconsciousness, 
but it was never continuous. The four or five 
hours were made up of bits ; and if one of the 
bits was two hours long, it was something un- 
usual. Ordinarily my nights had from a dozen 
to a score of wakings. Moreover, at that time 
and for five and twenty years after the sensa- 
tion of drowsiness was never experienced." 

This paragraph from the life's record of one 
of our greatest thinkers should reassure many 
an insonmiac. 

Rest Without Sleep. — The object of sleep is 
refreshment and this may be obtained in a 
measure from rest alone. If the insomniac can 
adopt the attitude that he will take as much re- 



EEQUISITE QUANTITY OF SLEEP 67 

freshment as he can from rest alone and if he 
will put himself in the attitude of mind favour- 
able to receive this frequently, sleep will steal 
upon him while he is resting. If he can con- 
vince himself that he is neither threatened with 
insanity nor a physical breakdown from a few 
nights of disturbed sleep and that he can get 
sufficient refreshment of mind and body from a 
few hours sleep plus a great deal of rest, he will 
have advanced a considerable way on the road 
to recovery. Too many sufferers from in- 
somnia delude themselves into the belief that 
the number of hours of sleep that is good for 
them is the greatest number they can get. 
While the stress of sleeplessness is upon them, 
their appetite for it is similar to that for water 
in those parched with thirst. While in this 
state, they are sure that they could drink a 
bucket of water if it were at hand but when that 
amount and more is tendered them, their thirst 
is slaked with a few ounces. 

Illustrious Insomniacs. — I have been able to 
assist many sufferers from sleeplessness by cit- 
ing the example of such great insonmiacs as 



68 SLEEP AND THE SLEEPLESS 

Charles Darwin. *'His nights," his son tells 
Tis, ' ' were generally bad and he often lay awake 
or sat up in bed for hours suffering much dis- 
comfort. He was troubled at night by the ac- 
tivity of his thoughts and would become 
exhausted by his mind working at some problem 
which he would willingly have dismissed. At 
night anything which had vexed or troubled him 
in the day would haunt him." Yet the testi- 
mony of this same son is that his children saw 
liim despite this and his habitual suffering ' ' full 
of pleasure in what pleased them," and the 
world owes him the greatest contribution ever 
made to the scientific conception of the origin 
of man. It should help insomniacs to take pa- 
tience with their lot to read how this great man 
ordered his daily life that he might secure the 
fullest benefit from the few hours sleep that 
were vouchsafed him. 

Napoleon, Frederick the Great, Charles XLC, 
the Duke of "Welling-ton, to mention but a few, 
were among the great men who considered sleep 
a luxury rather than a necessity and the old 
English saying; 



EEQUISITE QUANTITY OF SLEEP 69 

''Nature requires five, 
Custom gives seven, 
Laziness takes nine, 
And wickedness eleven,'* 

has more than a little truth in it. 

Virgil and Horace, Franklin and Priestley, 
Parkhurst and Buffon, achieved their best work 
on a minimum of sleep. Sir Thomas Moore 
rose regularly every morning at four o'clock 
and so convinced was he of the beneficial ef- 
fects of early rising that in his Utopia, he rep- 
resented its inhabitants as attending lectures 
before sunrise. John Hunter, one of the 
world's gTeatest anatomists and surgeons, was 
able to retire to his dissections, his books and 
his writings, after a long and busy day in the 
active practice and teaching of surgery and 
after three or four hours sleep^ arise fresh and 
vigorous for another day as full of work. 

More than half a century ago a learned 
Scotchman, MacManish by name, wrote : * ' The 
same forces which regulate our desire for food 
also govern sleep. As we indulge in sleep in 



70 SLEEP AND THE SLEEPLESS 

moderation or excess, it becomes a blessing or 
a curse ; in the one case recruiting the energies 
of nature, and diffusing vigour alike over the 
mind and frame, in the other debasing the char- 
acter of man, stupefying his intellect, enfeebling 
his body and rendering him useless alike to oth- 
ers and to himself. The glutton, the drunkard, 
and the sloven, bear the strictest affinity to each 
other, both in the violation of nature 's laws, and 
in the consequence hence entailed upon them- 
selves. "What in moderation is harmless or 
beneficial, in excess is a curse, and sleep, car- 
ried to the latter extreme, may be pronounced 
an act of intemperance almost as much as ex- 
cessive drinking or eating." 

Let the insomniac then take heart. A life of 
personal satisfaction and general usefulness is 
not inseparable from eight hours sleep nightly. 
If he can spend four or five hours each night in 
sleep, let him consider that much as food and 
every hour added as pleasant but unessential 
dessert. 

Let him fill himself with the thought that rest 
may re-vitalise him quite as effectively as sleep, 
and, instead of tossing and turning and work- 



EEQUISITE QUANTITY OF SLEEP 71 

ing himself into a temper, let him lie at ease 
in bed and relax his contracted muscles and 
nerves. He will not be injured by merely not 
sleeping. It is the unrest of his body and mind 
while he is not sleeping that will work him harm. 
Let him control his mind and body and maintain 
them passive and placid and insomnia will lose 
its horror for him. 



CHAPTER VIII 

SURROUNDINGS CONDUCIVE TO SLEEP 

Whethee or not the physical combine with the 
mental in causing insomnia, there are always 
certain conditions of stage setting, as it were, 
which if observed will facilitate, if not produce 
sleep. The general principles applicable to the 
treatment of sleeplessness must consider the 
individual and his environment. Some envi- 
ronments are contributory to slumber, peaceful 
and refreshing, just as others are provocative 
of wakefulness. One man, however, may sleep 
soundly in quarters and in an atmosphere that 
will move another to the most fundamental pro- 
test and rebellion. 

The Bedroom. — The bedroom should be large 
and airy and light should be excluded there- 
from, also all unnecessary hangings. A person 
suffering from insomnia should safeguard him- 
self from all external stimuli which annoy and 
irritate him. As to ventilation, read Benjamin 
73 



74 SLEEP AND THE SLEEPLESS 

Franklin on the advantage to be derived from 
sleeping in rooms that are properly aired. 
''It has been a great mistake," says he, ''this 
sleeping in rooms exactly closed and in beds 
surrounded by curtains. No outward air that 
may come into you, is so unwholesome as the 
unchanged air, often breathed, of a close cham- 
ber. As boiling water does not grow hotter by 
longer boiling, if the particles that receive 
greater heat can escape, so living bodies do not 
putrefy, if the particles, as fast as they become 
putrid, can be thrown off. Nature expels them 
by the pores of the skin and lungs ; and in a free 
open air they are carried off; but, in a close 
room, we receive them again and again, though 
they become more and more corrupt. A num- 
ber of persons, crowded into a small room, thus 
spoil the air in a few minutes, and even render 
it mortal, as in the Black Hole at Calcutta. A 
single person is said to spoil only a gallon of 
air per minute, and therefore requires a longer 
time to spoil a chamberful ; but it is done, how- 
ever, in proportion and many putrid disorders 
hence have their origin. It is recorded of 
Methusalem, who being the longest liver, may be 



CONDUCIVE SURROUNDINGS 75 

supposed to have best preserved his health, that 
he slept always in the open air, for, when he had 
lived 500 years, an angel said to him, 'Arise, 
Methusalem, and build thee an house, for thou 
shalt live yet 500 years longer.' But Methu- 
salem answered and said, 'If I am to live but 
500 years longer, it is not worth while to build 
me an house — I will sleep in the air as I have 
used to do/ Physicians after having for ages 
contended that the sick should not be indulged 
with fresh air, have at length discovered, that 
it may do them good. They may, in time, dis- 
cover likewise, that it is not hurtful to those who 
are in health." 

When confined air becomes saturated with 
perspirable matter, the rest of that matter re- 
mains in our bodies, and so occasions disease, 
but it gives some previous notice of its future 
harm by producing certain uneasiness, slight in- 
deed at first, such as a trifling sensation with 
regard to the lungs and a kind of restlessness to 
the pores of the skin. This restlessness is dif- 
ficult to describe, and few that feel it know the 
cause of it. But we may recollect, that some- 
times on waking in the night, we have found it 



76 SLEEP AND THE SLEEPLESS 

difficult, if warmly covered, to get to sleep 
again. We turn frequently without finding re- 
pose in any position. This fidgetiness is occa- 
sioned wholly by an uneasiness in the skin, 
owing to the retention of the perspirable mat- 
ter. T\Tiat physicians call the perspirable mat- 
ter, is that vapour which passes off from our 
bodies, from the lungs, and through the pores of 
the skin. The quantity of this is said to be five- 
eighths of what we eat and drink. 

Each individual must be considered in refer- 
ence to his habits and customs regarding prep- 
aration for sleep; whether it be for walking, 
bathing, reading, eating, drinking, smoking, ab- 
straction, planning, poetising or praying. 
Some persons feel it essential to have some eas- 
ily digested food or mildly stimulating drink 
before retiring, others are convinced that read- 
ing or being read to facilitates the coming of 
Nature's soft restorer. Others find it essential 
to smoke. Then, of course, there are faddists ; 
those who must walk about unclad in the cool 
air, those who must have certain kind of bed 
clothing, those who must breathe in a particu- 
lar way, etc., etc. 



CONDUCIVE SUEEOUNDINGS 77 

Baits to Catch Sleep. — Many poor sleepers 
outwit the demon that is persecuting them by- 
resorting to some method of dulling the senses 
either by gazing steadily at some object until 
their eyelids feel heavy when they hope to bridge 
the strait between momentary fatigue and gen- 
uine sleep at one leap, or by listening to some 
monotonous sound or calling up some particu- 
larly sedative scene or tiresome experience. 

That sleep often results from monotonous 
repetition of one kind of stimulation, noise, 
sound or light everyone knows. The efficacy 
of the rhythmical rocking of the cradle, the 
monotonous chant of the lullaby, the sound of 
running water, and the dull voice of the monot- 
onous lecturer, all testify to this. In fact many 
insomniacs successfully utilise it to produce 
sleep. Wordsworth would sleep by calling up 
in his mind's eye: 

A flock of sheep which leisurely pass by 
One after one ; the sound of rain, and bees 
Murmuring ; the fall of rivers, wind and seas. 
Smooth fields, white sheets of water and pure 
sky, 



78 SLEEP AND THE SLEEPLESS 

but to do tliis successfully one has to have what 
may be called the meditative faculty. 

One of the most amusing contributions to the 
literature of efforts of this kind is furnished by 
Southey who describing one of his sleepless 
nights said, '' I listened to the river and to the 
ticking of my watch; I thought of all sleepy 
sounds and of all soporific things — the flow of 
water, the humming of bees, the motion of a 
boat, the waving of a field of corn, the nodding 
of a mandarin's head on the chimney piece, a 
horse in a mill, the opera, Mr. Humdrum's con- 
versation, Mr. Proser's poems, Mr. Laxative's 
speeches, Mr. Lengthy 's sermons. I tried the 
device of my own childhood and fancied that the 
bed rushed with me round and round. At 
length Morpheus reminded me of the Torpedo's 
Divinity lectures, where the voice, the manner, 
the matter, even the very atmosphere and the 
streaming candle-light were all alike soporific; 
when he who, by strong effort, lifted up his head 
and forced open the reluctant eyes never failed 
to see all around him asleep. Lettuces, cowslip 
wine, poppy syrup, mandragora, hop pillows, 
spiders' web pills, and the whole tribe of nar- 



CONDUCIVE SUEEOUNDINGS 79 

cotics up to bliang and the black draught would 
have failed; but this was irresistible, and thus 
twenty years after date I found benefit from 
having attended the course." Long distance 
suggestion most of us would call this, but still a 
brilliant and convincing testimonial to the power 
of monotonous stimulation. 

The place to sleep is in a comfortable bed in 
the open air if possible. Circumstances are 
such that for the vast majority it is impossible 
to sleep out of doors. To sleep in a draught is 
the next best place. There are few things that 
contribute to sleep as does fresh, pure air. It 
has taken us a long time to realise this and 
sleeping in rooms that are practically unven- 
tilated is still unquestionably the habit with the 
majority of people. ''The damp night air" is 
the bogey man for countless grown-ups still. 
Not only do the lungs and blood need air at 
night but so does the skin. Yet notice the pre- 
caution that we take with blanket and wadded 
covering to make sure that it does not get in. 
The child, the savage and the primitive man 
kick them off. Nature has her way. But once 
convention gets them in her grasp, then they 



80 SLEEP AND THE SLEEPLESS 

stay ' ' tucked in. ' ' In this country we have been 
delivered from the bondage of the feather tick 
but we are still struggling with heavy, nearly 
air-impervious blankets. 



CHAPTER IX 

TREATMENT 

Training the Mind.— Since the chief sonrce 
from which insomnia flows has to do with a 
troubled mind, it follows that the most etfective 
remedy is the restoration of tranquillity and 
the .bringing of the mind under control. Where 
there is fear of sleeplessness this fear must be 
banished. If the insomniac is in a state of 
mental irritability and exaltation he must force 
from his mind the thoughts that occasion such 
irritability and exaltation, just as he would force 
from his hearing the conversation of those all 
about him while he is being spoken to over the 
telephone. The training of the mind in this 
sort of concentration will help wonderfully in 
his battle against insomnia. To be able to read 
while the piano is being played in the next room 
requires the same mental effort necessary in 
forcing sleep-dispelling thoughts from the muid. 
If the noise of the piano may be shut out, the 
81 



82 SLEEP AND THE SLEEPLESS 

will to be awake may be overcome. The hand 
may guide the pencil over the paper in markings 
of innumerable down strokes without the brain 
associating itself with the act, or else each fig- 
ure "1" traced by the pencil may be followed 
intently in the mind. 

If instead of allowing fear of approaching 
business disaster to fill his thoughts the insom- 
niac will busy his brain observing and noting 
his breathing and bring all his mental atten- 
tion to the task of aspiration and exhalation in 
slow measured tempo, he will soon find himself 
sleeping peacefully. Just as sleep may not be 
had while the teeth are clenched, the fists 
doubled up and the muscles and nerves strained 
and contracted, it may not be obtained while the 
thoughts are jumping from one subject to an- 
other as birds jump from branch to branch of a 
tree, chirping and twittering, but apparently ac- 
complishing nothing. The mind may be as in- 
tently occupied in regulating the breathing, in 
relaxing the muscles of the body and untighten- 
ing the nervous system as in speculating over 
the probable fluctuations of the stock market on 



TREATMENT 83 

the morrow or the likelihood of one's position 
being suddenly lost. 

Physical Aids. — Many "systems" of breath- 
ing have been urged by physicians of this and 
other generations as methods of facilitating 
sleep. In the early part of the nineteenth cen- 
tury one Gardner, who styled himself an 
"hypnologist," urged sufferers from insomnia, 
after takiag a comfortable position with the 
pillow occupying exactly a right angle line 
drawn from the head to the shoulders, to take 
a full inspiration through the nostrils with lips 
closed. Having taken this full inspiration, 
the lungs are then left to their own action — 
that is, the respiration is neither to be ac<ieler- 
ated nor retarded. During this operation, the 
patient must fix his attention wholly and com- 
pletely upon his breathing. He must fancy to 
himself that he sees the breath passing from 
his nostrils in a continuous thread. The in- 
stant he brings his mind to conceive this to the 
exclusion of all other ideas, consciousness and 
memory depart, imagination slumbers, thought 
ceases, the sentient faculties lose their suscep- 



84 SLEEP AND THE SLEEPLESS 

tibility, the vital or ganglionic system assumes 
sovereignty and the individual sleeps. 

A somewhat similar method was recently 
published by Dr. J. B. Learned. The principle 
is to induce muscular fatig-ue by exercises car- 
ried on in bed. He describes the method as 
follows: Lying on his back, the patient first 
reaches for the foot and head board at the same 
time, he then raises his head half an inch; 
at the same time he breathes slowly and deeply 
about eight inspirations to the minute, which 
are counted. After about twenty inspirations, 
the head which begins to feel heavy, is dropped. 
The right foot is then raised, the reaching for 
the boards and counting being continued, and 
similarly dropped when fatigued. The left 
foot goes through the same process. The mus- 
cles which are used in reaching for the head 
and foot boards are then relieved, and the body 
is elevated so that it rests on the head and 
the heels. He then turns on the right side and 
reaches for the head and foot as before. The 
same process is gone through on the other side. 
Thus eight positions have been assumed and a 
large number of muscles used. If sleep has 



TREATMENT 85 

not been induced the same cycle is gone over 
again. 

The method is a strenuous one hut I have 
seen it act in able-bodied hypochondriacs in the 
most gratifying way. 

A well-known educator and moralist, the 
president of a New England college, advocates 
the following : 

*' Assume an easy position, with the hands 
resting over the abdomen. Take a long, slow, 
but easy natural breath in such a way as gradu- 
ally and gently to lift the hands outward by the 
action of the abdomen. At the same time 
gradually and slowly open the eyes, so that at 
the end of the inspiration they are wide open 
and directed upward. Let the breath out 
easily and naturally, letting the hands fall in- 
ward as the outward pressure of the abdomen 
is withdrawn. At the same time let the eyes 
drop and the eyelids naturally fall by their 
own weight, so that they are closed at the end 
of the expiration. Do all this quietly and nat- 
urally. Do not make hard work of it. 

"Repeat the inspiration and expiration with 
opening and lifting, dropping and closing of the 



86 SLEEP AND THE SLEEPLESS 

eyes ten times. Then take ten breaths in the 
same way, allowing the eyes to remain closed. 
Alternate ten breaths with closed eyes. 

''When the eyelids begin to feel heavy, and 
you feel tired and sleepy, as you will very soon, 
go through the motions more and more easily 
and lazily, until you merely will the motions 
without making any effort, or hardly any effort, 
to execute them. At this stage, or, more likely, 
in one of the intervals of breathing without any 
motion of the eyes, you will fall asleep. 

' ' This rule gives the mind two gangs of work- 
men, two sets of muscles to watch and keep 
working in harmony. It cannot do this and 
take account of the work done and at the same 
time keep up much of a thinking about anything 
else. 

"It induces the respiration that is character- 
istic of normal sleep. It tires the set of mus- 
cles the tiring of which is one of the favourite 
devices for producing hypnosis. It produces 
and calls attention to certain sensations in the 
eyelids which are the normal precursors of 
sleep. It alternates work in such a way as to 



TREATMENT 87 

make resumption of work more and more un- 
welcome and rest more and more grateful.*' 

Exercise. This leads to the consideration of 
exercise as an adjunct in the treatment of in- 
somnia. Probably nothing that the insomniac 
can do will bring such gratifying returns as 
appropriate exercise. The best sort of exer- 
cise will be the kind that he likes to take and 
that will fatigue. For the hunter, it is tramp- 
ing with a gun on his shoulder and a dog at his 
heels ; for the golfer it is going about the links 
with a good-natured, honest opponent whom he 
can beat on the seventeenth green; for the 
sportsman it is following the hounds on a mount 
which is the envy of every man in the county 
who knows anything about horse flesh; and so 
©n throughout the list. Most insomniacs, how- 
ever, must content themselves with walking and 
bicycling, and such simple gymnastics as medi- 
cine ball and tennis, while for others boxing, 
fencing, swimming, rowing, tennis, squash, and 
riding may be possible. When the insomniac 
has no disorder that precludes walking, this is 
the exercise that may be recommended to him 



88 SLEEP AND THE SLEEPLESS 

with assurance that if he will devote enough 
time to it, sleep will be sure to come to him. 

Food and Drink Before Retiring. — Benjamin 
Franklin, writing on the Art of Procuring Pleas- 
ant Dreams, has this to say: 

"Exercise should precede meals, not imme- 
diately folloiv them; the first promotes, the 
latter, unless moderate, obstructs digestion. If, 
after exercise, we feed sparingly, the digestion 
will be easy and good, the body lightsome, the 
temper cheerful, and all the animal functions 
performed agreeably. Sleep, when it follows, 
will be natural and undisturbed. While indo- 
lence, with full feeding, occasion nightmares, 
and horrors inexpressible; we fall from preci- 
pices, are assaulted by wild beasts, murderers 
and demons; and we experience every variety 
of distress. Observe, however, that the quanti- 
ties of food and exercise are relative things; 
those who move much, may and indeed ought 
to, eat more; those who use little exercise, 
should eat little. In general, mankind, since 
the improvement of cookery, eats about twice 
as much as nature requires. Suppers are not 
bad, if we have not dined; but restless nights 



TEEATMENT 89 

naturally follow hearty suppers, after full din- 
ners. Indeed, as there is a difference in consti- 
tutions, some rest well after these meals; it 
costs them only a frightful dream, and an apo- 
plexy, after which they sleep until Doomsday. 
Nothing is more connnon in the newspapers 
than instances of people, who, after eating a 
hearty supper, are found dead abed in the morn- 
ing. 

"Not a few find it advantageous to expose 
the unclad body to the cool air, to make cold 
ablutions, to take warm foot baths or to hold 
the feet for a few seconds under running cold 
water. All of these may at times be indulged 
in advantageously, especially if the insomnia 
is due to mental causes or upon habit." 

Other Devices. — ^Another recommendation of 
Benjamin Franklin that has fallen into disre- 
pute which it does not deserve, I quote here : 

'^A shock of cold water has always appeared 
to me, generally speaking, as too violent, and 
I have found it much more agreeable to my 
constitution to bathe in another element. I 
mean cold air. With this view, I rise almost 
every morning and sit in my chamber without 



90 SLEEP AND THE SLEEPLESS 

any clothes whatever, half an hour or an hour, 
according to the season, either reading or writ- 
ing. The practice is not in the least painful, 
but on the contrary agreeable ; and if I return 
to bed afterwards, before I dress myself, as 
sometimes happens, I make a supplement of 
my night's rest of one or two hours of the most 
pleasing sleep that can be imagined. I find no 
ill consequences whatever resulting from it, and 
that at least it does not injure my health, if it 
does not in fact contribute much to its preser- 
vation. I shall therefore call it for the future 
a brainy or tonic bath." 
And in another connection he writes: 
''Wlien you are waked by any uneasiness, 
and find you cannot easily sleep again, get out 
of bed, beat up and turn your pillow, shake the 
bedclothes well, with at least twenty shakes, 
then throw the bed open, and leave it to cool ; in 
the meanwhile, continuing undrest, walk about 
your chamber, till your skin has had time to 
discharge its load, which it will do sooner, as 
the air may be drier and colder. When you be- 
gin to feel the cold air unpleasant, then return 
to your bed ; you will soon fall asleep, and your 



TEEATMENT 91 

sleep will be sweet and pleasant. All the scenes 
presented to your fancy, will be of the pleasing 
kind — I am often as agreeably entertained by 
them as by the scenery of an opera. If you 
happen to be too indolent to get out of bed, you 
may, instead of it, lift up the bedclothes with 
one arm and leg, so as to draw in a good deal 
of fresh air, and, by letting them fall, force it 
out again. This repeated twenty times, will so 
well clear them of the perspirable matter they 
have imbibed, as to permit your sleeping well 
for sometime afterwards. But this latter 
method is not equal to the former. 

''Those who do not love trouble and can 
afford to have two beds, will find great luxury, 
in rising when they wake in a hot bed, and 
going into the cool one. Such shifting of beds 
would also be of great service to persons ill of 
a fever, as it refreshes, and frequently procures 
sleep. A very large bed, that will admit a re- 
moval, so distant from the first situation as to 
be cool and sweet, may, in a degree, answer the 
same end." 



CHAPTEE X 

PRINCIPAL CURATIVE AGENCIES 

Baths. — Of the known physical measures in 
the treatment of insomnia the external applica- 
tion of water is among the most efficacious. 
A prolonged warm bath ('98 to 102 degrees 
Fahrenlieit, lasting from ten to twenty-five 
minutes) with the addition of some volatile sub- 
stance that irritates the skin and causes a 
gentle, pleasant stimulation of the blood circu- 
lation on the surface of the body, such as pine 
needle extract, is frequently most serviceable 
in overcoming insomnia due to fatigue, exhaus- 
tion, worry and disagreeable sensations, not 
amounting to real pain, coming from different 
parts of the body. 

Insomnia associated with pain of what is 
commonly called a rheumatic nature, that is, 
pain due to inadequate elimination from the 
system of products of combustion, and insomnia 
accompanied by motor unrest commonly called 
93 



94 SLEEP AND THE SLEEPLESS 

''fidgets" is frequently relieved by a bath at the 
temperature of from 102 to 108 degrees F., and 
of ten minutes ' duration. Upon emerging from 
this bath, the individual should wrap himself 
in a warm flannel blanket until all the moisture 
is absorbed, when he is ready to don his night 
clothes and sink peacefully into sleep. 

When there is no constitutional weakness and 
the system is able to withstand the shock of 
cold water, the treatment known as the drip- 
ping sheet has proven of great benefit. The 
patient stands in a foot tub of hot 'water with 
a towel dripping with ice water wrapped about 
his head. A linen sheet is then taken unwrung 
from a basin of ordinary cold water (60 de- 
grees) and thrown over the back of the patient 
while a few rapid movements of the hand bring 
it in contact with every part of the body. Brief 
friction is made through the sheet after which 
it is removed, the body dried quickly and the 
patient put to bed. Often sleep follows within 
a few minutes. 

Another method tried with success is the 
abdominal compress. The method here is to 
apply a compress of four or more layers of 



PRINCIPAL CUEATIVE AGENCIES 95 

flannel, large enough to cover the entire abdo- 
men, taken dripping from cold water of from 
50 to 60 degrees. This is covered with enough 
flannel to keep the clothing from getting wet 
and is allowed to remain in position an hour 
or more and even through the entire night 
should the patient be found to be asleep and the 
removal of the compress render likely his awak- 
ening. 

So-called tonic baths have also been found 
of great remedial value. As given in hydriatic 
establishments they consist in the vigorous ap- 
plication of water, alternately hot and cold, 
from the nozzles of water hose under adjust- 
able pressure and through perforated pipes 
arranged as a circular cage and known as needle 
and shower baths. 

Taken during the day, the tonic bath invig- 
orates the patient, invites him to beneficial ef- 
fort such as exercise, favours the sensation of 
relaxation and improves the circulation and 
nutrition. Taken at the bedtime hour, it has 
a sedative effect. At first, extremes of temper- 
ature should be avoided, as otherwise the end 
which is desired may be defeated and the pa- 



96 SLEEP AND THE SLEEPLESS 

tient become more excited than before. A mod- 
erately low temperature of from 65 to 70 
degrees, reduced two or three degrees at every 
application, I have found to be more practical 
than an extremely low temperature from the 
first. It has been my experience that patients 
respond better if they become accustomed to the 
use of cold water than if a cold blanket, so to 
speak, is thrown over them from the first. 
Many patients thus treated never recover their 
confidence sufficiently thereafter to make ready 
response to the treatment and it is therefore 
wiser to make haste slowly and not try to cure 
by one application. 

Where the patient may not avail himself of 
the commodities of a hydriatic establishment, 
the following substitute may be resorted to. 
The patient sits or reclines for five minutes in a 
tub half or one-third full of water at a tempera- 
ture of from 75 to 85 degrees, while the skin is 
vigorously frictioned by an attendant or nurse. 

Packs — ^Warm and Cold. — Very good results, 
particularly in individuals of a high-strung and 
nervous temperament have been obtained from 
the use of cold packs and warm packs. The 



PRINCIPAL CUEATIVE AGENCIES 97 

drawback to them is that they may only be ap- 
plied by trained nurses or individuals ha\TJig 
had some experience. A cold pack at bedtime 
relaxes the nerves and invites repose. The 
sensation of tension nearly always present is 
relieved and sleep readily induced, particularly 
if a gentle massage follows. 

The night wet pack is administered as fol- 
lows : First spread upon the cot or bed three 
large sized woollen blankets with the top ends 
placed half way over the pillow in order that 
they may be drawn smoothly about the neck 
and shoulders, then spread over the blanket a 
linen sheet or a large sized table cloth wrung 
out of water at 75 degrees (reduced two de- 
grees each succeeding application). The sheet 
must be wrung as dry as possible, as any 
superfluous moisture retards reaction. After 
spreading the sheet upon the blankets which 
have already been prepared the patient is in- 
structed to lie down and one end of the sheet 
is brought around the body (the aim meanwhile 
having been raised), then over one leg in order 
that no part of the body touches another. Then 
lower the arms and wrap the other edge of the 



98 SLEEP AND THE SLEEPLESS 

sheet over the arms and between the legs. If the 
feet are cold it may be wiser not to wrap them 
in wet sheets. The blankets are then wrapped 
about the patient as securely as possible in or- 
der to exclude the air. The patient having 
been placed in the middle of the blanket, there 
must be an even margin on either side which 
must be wrapped alternately beginning at the 
neck where it must be wrapped closely and 
firmly though it must not bind across the back 
of the neck or throat either of which will pro- 
duce a headache. After the first layer of 
blanket is put about the patient a hot water bot- 
tle can be placed against the feet, care being 
taken that it is not too hot or too near the wet 
sheet. The remaining layers of the blanket are 
then arranged alternately, and lastly a cold 
compress is placed on the head and changed 
occasionally. 

A glass of water may be given twice during 
the hour that the patient is in the pack. Be- 
fore it is time to remove the patient from the 
pack, the half bath should be prepared. Draw 
water of the required temperature (90 to 
95 °F.) about a foot in the bath tub, then have 



PEINCIPAL CUEATIVE AGENCIES 99 

a foot tub or other receptacle filled with water 
10 degrees lower with a dipper at hand to use 
for the effusions. 

In removing the patient from the pack he 
should not be entirely exposed, but leave one 
blanket to protect from chilliness on the way 
to the bath. Immediately upon entering the tub 
the patient should be rubbed vigorously over 
the entire body and the exposed portion, which 
will be from the waist up, must not only be 
rubbed but slapped, not with a heavy blow, but 
a light, tingling slap, followed by water dashed 
upon the shoulders and chest. Have at hand a 
linen sheet and wrap it around the patient when 
taken from the tub and rub quickly (not with 
the sheet) until dry, using friction and slapping. 
This procedure is frequently enhanced by mas- 
sage after the patient has been put to bed, and 
by giving some hot drink. 

Massage. — Insonmiacs whose sleep disturb- 
ance can be traced to mental causes find great 
relief in massage. The best results are ob- 
tained by subjecting the patient to gentle mas- 
sage and inducing physical reaction and mental 
appeasement by light surface contact. Where 



100 SLEEP AND THE SLEEPLESS 

there are no bodily infirmities and where it is 
necessary to occasion a certain degree of lassi- 
tude, the treatment may be more vigorous and 
partake of the rough fundamental muscle knead- 
ing given to athletes. 

Massage for insomnia must vary with the 
patient. A high-strung, nervous patient should 
be treated in the morning or early in the day — 
otherwise he or she will get wide-awake and 
excited. Others will be soothed and fall into a 
quiet sleep after an evening treatment. The 
operator is instructed not to talk to the patient, 
especially after the back has been attacked and 
to finish the treatment with long, gentle strokes 
on the head and down the arms. The patient 
will then be turned on the side and covered 
properly and the windows opened wide. 

In many instances, massage of the feet is of 
great service. I have also observed that in 
cases of sleeplessness springing from the con- 
tinued occurrence of the same train of thought, 
the insomnia will yield to light massage of the 
head. Many nervous individuals go to sleep 
easily while their hair is being smoothed, a sur- 
vival of a custom long practised in the nursery. 



PEINCIPx^L CUEATIVE AGENCIES 101 

Bed-time Suppers. — ^Whether or not insom- 
niacs should take food upon retiring is a ques- 
tion which physicians are frequently called 
upon to answer. All that can be said is that 
it depends upon the individual and upon his 
habits and customs. 

It is a fact that the average human being 
feels a physical drowsiness after taking food. 
This phenomenon occurs not only in human be- 
ings, but in all animals. It is very manifest in 
the lower animals, all of whom display the 
greatest disinclination to be active after feed- 
ing. In a general way, it may be said that it is 
prejudicial to health to consume such a quan- 
tity of food as will cause a sensation of leaden 
drowsiness after it is taken. 

The relationship which exists between insom- 
nia and indigestion is only once removed from 
that which exists between normal digestion and 
drowsiness. 

A bedtime supper is likely to be injurious to a 
person who has taken a full meal only three 
hours earlier. On the other hand, those who 
are accustomed to taking only a light supper 
and that early in the evening jSnd their sleeping 



102 SLEEP AND THE SLEEPLESS 

greatly benefited by taking a glass of sour milk 
and a biscuit, a cup of hot malted milk (pro- 
viding tbey have no tendency to sour stomach) 
or a cup of hot broth on retiring. This comes 
from the fact that many who suffer from insom- 
nia have disordered nutrition and lowered vi- 
tality. To counteract this, it becomes advisable 
to get easily digested food into them frequently. 
We therefore have to avail ourselves of the bed 
hour to administer it and if we find, as is some- 
times the case, that such administration facili- 
tates going to sleep, it is gratifying. Par- 
ticularly is this overfeeding effective where 
intestinal indigestion and disorder of the blood- 
vessels exists. In these cases it has been found 
that the digestion of a large amount of food is 
conducive to sleep. It is currently stated that 
such somnolence is due to cerebral starvation 
of the brain caused by the demands of the stom- 
ach upon the available energy, but it is more 
legitimate to attribute it to a form of self -intoxi- 
cation. 

The maxim that "We all eat too much," while 
it contains some truth, is not nearly so all-em- 
bracing as the statement that what is too much 



PRINCIPAL CURATIVE AGENCIES 103 

food for one person is not enough for another. 
One of the healthiest men I have ever known 
who died at eighty-three from natural causes 
ate every day of his life quite enough food to 
sustain a small family. I never heard him ask, 
''Is it good for me?" and he ate what he liked 
and as much of it as he craved. Were his neigh- 
bour to do the same, he would soon fall a victim 
to gout or become subject to depression and 
inertia. Overeating has relation to insomnia 
only in that it causes indigestion and disease 
of the arteries. 

Electric Treatment. — Electricity which at one 
time or another has been hailed as curative of 
practically every disease has been tried with 
varying success for the treatment of insomnia. 
Aside from the fact that the high frequency 
current generated from a static machine is not 
accessible from one's bedroom, its value as a 
calmant is doubtful. Occasionally the high fre- 
quency current has been known to bring on 
drowsiness but the evidence is just as conclu- 
sive that it excites quite as frequently as it 
soothes. 



CHAPTEE XI 

OPIATES AND NARCOTICS 

Drugs not a Cure. — Insomnia cannot be cured 
by drugs. It can be cured only through the 
detection and eradication of its causes, by the 
utilisation of measures to develop strength, tone 
and vitality, and by the adoption and mainte- 
nance of a sane point of view which means in 
a great many instances strengthening the will 
power. 

To compel sleep by opiates or sedatives is not 
to cure sleeplessness. It is idle to attempt to 
cure insomnia by the taking of drugs whose 
most striking effect is to produce it. Not only 
is it bound to fail, but nearly always it leads to 
the formation of a habit, the continuance of 
which is subversive of happiness and health and 
leads the patient into a slough of unhappiness 
and despondency. 

When the brain has been overtaxed by en- 
grossing work or when the nervous system has 
105 



106 SLEEP AND THE SLEEPLESS 

been shattered by severe shock, exhausted by 
terrible anxiety or worn by excitement or vigils, 
a judiciously selected sedative may bring re- 
pose to the body and refreshment to the brain 
and so break the wakeful habit and restore the 
sufferer's confidence. But this is not a cure of 
insomnia nor is it a license to take narcotics 
whenever one is wakeful. The physician who 
is most earnest in his efforts to overcome in- 
somnia in others is the last person to minimise 
their value. But no word of warning can be 
too loud and no protest too emphatic against 
the general use of narcotics. All such drugs 
are injurious and health destroying and their 
repeated continuance and administration is both 
unscientific and dangerous. 

In view of the fact that the truth of this 
statement is universally admitted, it is difficult 
to understand how some supposedly intelligent 
persons are willing to jeopardise their health 
and happiness by taking drugs on the slightest 
provocation. The administration of narcotics 
leaves the cause of the sleeplessness untouched. 
The system becomes accustomed to the drug 
and larger and larger doses are required to 



OPIATES AND NAECOTICS 107 

produce the desired effect. Even when this ef- 
fect is produced, it is at the expense of impaired 
digestion, disordered circulation and deterio- 
ration of the blood. On the morale of drug- 
takers the effect is even more disastrous. The 
victim of insomnia who has had his suffering 
momentarily assuaged by some sleeping pow- 
der, is no longer willing thereafter to bear with 
equanimity or to tolerate with patience a pri- 
vation of sleep which previously he bore philo- 
sophically. Why lie awake till dawn when the 
peace of oblivion may be had through the ab- 
sorption of an allegedly harmless powder made 
agreeable to taste by the apothecary? Chiefly 
because each succeeding powder or potion 
diminishes the resistance and impairs the man- 
hood of the individual who takes it. "We con- 
stantly hear it said that modern narcotics such 
as sulphonal, trional, medinal and veronal are 
harmless or practically harmless as compared 
with chloral, opium and their derivatives. 
This is not true. They are less harmful inso- 
far as they induce habit less quickly, but the 
habit once formed is quite as pernicious and 
often more difficult to break. The most obsti- 



108 SLEEP AND THE SLEEPLESS 

nate example of drug addiction coming under 
my observation was one of sulplional habit. The 
patient, a young woman of high social position, 
has so far remained unmoved by the solicita- 
tions of her family, the appeals of her fiance 
and the commands of her physician. She dis- 
plays a combination of indecision and obstinacy 
which is not uncommon in narcotic habitues. 
This, combined with impairment of the moral 
sense which shows itself chiefly in bearing false 
witness and making statements at variance with 
facts, puts her beyond a physician's reach until 
after she shall have been adjudged an incom- 
petent. Indecision, impairment of memory, 
blunted moral sensibility in some form and 
bodily inertia are the customary results of 
sleep-medicine addiction. Many who point the 
finger of scorn at the drunkard, wrestling with 
an imperious and ofttimes inherited appetite, 
extend sympathy amounting to approbation to 
those who stultify their manhood by reaching 
out for the ever-ready tablet or powder that will 
give them temporary oblivion. 

Drugs Other Than Opiates. — The drugs that 
are of most general use in the treatment of 



OPIATES AND NARCOTICS 109 

insomnia are chloral and its compounds, bro- 
mide, paraldehyde, sulphonal, veronal, trional, 
medinal, opium and its derivatives. Of these 
the first and last are the most dangerous. 

The sleep that results from narcotics varies 
in depth and in capacity for refreshment, that is, 
in its after effects. The drug-induced sleep 
that most closely approximates the normal is 
that produced by chloral, or, as it is technically 
called, chloral hydrate. Next to opium and its 
derivatives it is the most dangerous of all nar- 
cotics. First, because it seriously disorders the 
heart and, second, because the formation of the 
chloral habit is very easy. The appetite for 
chloral demands to be sated as imperiously as 
the appetite for opium and cocaine. Even in 
the hands of a physician, the greatest care and 
discernment are needed and no one thinks of 
prescribing it without first ascertaining the con- 
dition of the heart. When no weakness of that 
organ exists, it may be taken in ten-grain doses 
when sleep is absolutely essential. Chloral, 
combined with other bodies, and derivatives of 
chloral such as chloralmide, chloralos, etc., have 
had a wide vogue. Chloralmide is less depress- 



no SLEEP AND THE SLEEPLESS 

ing to the heart and the circulation than chloral, 
but chloralos is more poisonous than chloral, 
though it depresses the circulation less. 

Examination of the prescription book of any 
pharmacy will reveal the fact that the salts of 
bromide, bromide of soda and bromide of po- 
tassium are more widely used than any drug 
in the pharmacopeia. The bromides are seda- 
tives of motion and sensation. They lessen 
irritability, whether it be of mind or body, and 
tend to soothe and assuage pain. The penalty 
that one pays for their use is very great. Taken 
for any considerable length of time, they de- 
stroy initiative, impair vitality, disturb the vege- 
tative functions of the body and produce 
physical and mental inertia. 

The products of the chemical laboratory, 
popularly spoken of as coal tar distillations of 
which the drugs cited ending in ''al" are types, 
enjoy a fictitious reputation for being prac- 
tically harmless. These sleeping tablets are so 
innocuous looking and their effect is so pleasant 
and efficient that it is difficult to convince the 
sufferer from insomnia that danger lurks in 
their habitual use. But every physician who 



OPIATES AND NARCOTICS 111 

has had experience in the treatment of so-called 
nervous diseases can testify that cases of 
chronic poisoning from one or all of these drngs 
is frequent and that disturbances of nutrition 
and serious ill-health often result from their 
indiscriminate use. I am sure that if it were 
generally known that such drugs as veronal, 
trional, medinal and sulphonal had the capacity 
to cause serious ill-health, which I know from 
experience they have, those who are tempted to 
take them just because they fear an hour or 
two of discomfort while awaiting sleep would 
think twice before doing so. 

The ideal narcotic is one that produces sleep 
of sufficient duration to refresh under all con- 
ditions and without ill effects or disagreeable 
after effects. It need scarcely be said that 
there is none. Some narcotics are less harmful 
than others and among these is paraldehyde. 
"Were it not for its disgusting taste and vile, 
persistent odour it might have more usefulness 
than it has. I have never seen paraldehyde 
taking degenerate into a habit. The aroma of 
it is such that no one can take it without adver- 
tising the fact. In states of apprehension, men- 



112 SLEEP AND THE SLEEPLESS 

tal perturbation, anxiety and depression a tea- 
spoonful or two taken in sugar water is suffi- 
cient to produce sleep. There is no narcotic 
that I recommend to patients with more sat- 
isfaction than this, for I am reasonably sure 
that they will not take it except as a last resort. 
Opiates, etc. — By far the most important of 
the narcotics is opium. Sleeplessness is founded 
so frequently in pain and discomfort that all 
that is required is cessation of them and sleep 
will follow. In the true sense of the term opium 
is not a narcotic at all. On the contrary, it 
often produces wakefulness, but by virtue of its 
unique capacity to assuage pain it is more 
widely used in combating sleeplessness than all 
the narcotics combined. For upward of two 
thousand years surcease of pain has been 
brought about by opium and its derivatives. 
Its usefulness to the human race is immeasura- 
ble. It is regrettable that one cannot say this 
without pointing out and emphasising the great 
danger of its slightest abuse. Probably no one 
is so ignorant of the capacities of opium as not 
to realise this. But only the physician and those 
who are so unfortunate as to have fallen into 



OPIATES AND NARCOTICS 113 

the bondage of opium can realise how terrible 
such servitude may be. It is nnfortunate for 
mankind that De Quincey and Coleridge took 
opium but more unfortunate that they told about 
it, or let it become known. Not a few even in 
my own experience have found it easy to con- 
vince themselves that their mental faculties 
would be stimulated and their endurance en- 
hanced by such indulgence. In the same way 
I have known the cocaine habit to develop in 
ambitious youths while Dr. Doyle was still ad- 
ministering the drug to Mr. Holmes to whet his 
sensibilities and to stimulate his capacity to 
draw logical conclusions. It is doubtful if the 
working capacity of the human machinery can 
be enhanced in any way temporarily by narcotic 
or stimulant, and for each loan that it accepts, 
or has thrust upon it, usurious interest has to 
be paid. This interest is invariably taken from 
the bank of health. 

There are many drugs that contribute to 
sleep by relieving pain, discomfort and distress. 
Such are phenacetin, acetanilid, aspirin, vale- 
rian, etc. Five to ten grains of phenacetin, or 
ten to fifteen grains of aspirin will frequently 



114 SLEEP AND THE SLEEPLESS 

transform a night made hideous by headache 
and insomnia into one of comparative comfort. 

From earliest times alcohol has been used 
to facilitate sleep. That it produces drowsiness 
in some, wakefulness in others is well known. 
It is at best but a temporary care-killer and 
save when taken in small quantities, highly in- 
jurious to the human race. Those who have 
observed the effect of its use and abuse are 
unanimous in the belief that the health and 
morals of all nations would improve if it were 
banished from the world. Its use to combat in- 
somnia is fraught with danger, 

AVhere insomnia is casual there are simple 
sedatives which will relieve. It is not an ad- 
mission of cowardice to take one of them, no 
more than putting an extra log on a fire is an 
admission on the part of the one who wants to 
be waim and comfortable, that he is a weakling. 
Nor is such indulgence injurious to the health 
or well-being. On the contrary, it may be and 
often is beneficial. It is when the physiological 
function of sleep is fundamentally disturbed 
and the attempt is made to restore it by drugs 
that the mischief begins. 



OPIATES AND NARCOTICS 115 

When the time comes when disease is no 
longer treated by drugs, save such drugs as have 
specific action : quinine in malaria, iron in ane- 
mia, arsenic in psoriasis, the millennium will be 
at hand. Drugs and chronic disease should be 
divorced forever. The use of drugs should be 
confined to the relief of conditions that are 
for the time intolerable, such as alkali to relieve 
the discomfort of a sour stomach, a laxative to 
stimulate the expulsive power of the large 
intestines, an analgesic to relieve pain. If there 
is a diseased state underlying these conditions 
it is to be combated by the administration of a 
specific or by the utilisation of such measures 
as contribute to the restoration of diseased tis- 
sues, — rest, exercise, occupation, recreation, 
fresh air, sunlight, food, water, heat, electricity, 
massage, suggestion, discipline and surgical aid. 



CHAPTER XII 

HYPNOTISM AND SUGGESTION 

Hypnotism. — Despite the interpretation of the 
phenomena of hypnotism in accordance with 
the principles upon which the science of psy- 
chology is founded there is still a widely held 
belief that hypnotism is induced by the action 
of a mysterious force or fluid which emanates 
from the operator. This would make of the 
hypnotiser a superman to be feared or revered, 
trusted or avoided, in proportion as confidence 
was felt in his morality or integrity. All this 
is nonsensical. No other force or fluid flows 
from the operator while hypnotising a subject 
than flows from a child modelling a snow man. 
The simple procedure in inducing hypnotism 
is first, to obtain obedience from and engender 
faith in the person to be hypnotised. The sub- 
ject being in a submissive attitude, without 
antagonism of will, is then asked to look stead- 
ily at an object. The operator will then say to 
117 



118 SLEEP AND THE SLEEPLESS 

him over and over, '^Go to sleep," assuring 
him the while that he will inevitably do so. No 
mysterious, occult or superhuman power save 
that to inspire confidence is needed. Hypno- 
tism is ordinarily induced by monotonous stim- 
ulation of one of the senses, such as fixed gaz- 
ing, and passes with contact or through central 
stimulation by means of suggested ideas or by 
both together. 

There is no doubt whatever as to the effect- 
iveness of hypnotism in inducing sleep. The 
fact, however, that it involves on the part of 
the person hypnotised a complete surrender of 
the will power and that each successive abdica- 
tion of effort will render the subject less able 
to exert his will, argues seriously against the 
use of hypnotism save as a last resort. The 
insomniac who relies upon the hypnotist for 
his sleep may find himself so dependent upon 
this unnatural and artificial subterfuge, as 
to be utterly unable to acquire sleep in any 
other manner. Hypnotism is all the more to 
be deprecated for the reason that direct or indi- 
rect suggestion during the waking state will 
prove fully as efficacious as suggestion made 



HYPNOTISM AND SUGGESTION 119 

during the hypnotic state. If the insomniac 
prove himself not amenable to simple sugges- 
tion, then and then only should he avail himself 
of the aid of hypnotism. The advantage of 
hypnotism lies in the great susceptibility to sug- 
gestion of the individual hypnotised. The sub- 
ject responds at once, even when the suggestion 
is made in the very lightest and shallowest 
stages of hypnosis. Indeed, in the treatment 
of insomnia by hypnosis the most successful 
practitioners only induce the lightest stages. 
Properly used, hypnotism may be of real serv- 
ice to the insomniac in aiding him to a 
restoration of a normal function, disturbed 
through apprehension or other emotional 
causes. But its use to overcome insomnia or 
any other disorder should be restricted nar- 
rowly to the physician and psychologist. The 
individual who seeks to avail himself of it for 
the relief of his suffering ought to feel absolute 
assurance that the person who utilises it knows 
what he is doing and what he aims to accom- 
plish. 

Suggestion. — Much mystery surrounding the 
response of the body to mental stimuli has 



120 SLEEP AND THE SLEEPLESS 

been dispelled. Although we are far from be- 
ing able to give a satisfactory explanation of 
the way in which the brain exerts its influence 
upon the remainder of the nervous system and 
upon the entire body, yet these effects having 
been definitely ascertained, the physician can 
avail himself of the cause with the confident ex- 
pectation that the result which he desires will 
be attained. 

The readiness of bodily action to follow upon 
mental conditions varies greatly in different 
subjects. Some measure of response to mental 
incitement is manifest in all and in many the 
reaction may be heightened by the appropriate 
conjunction of circumstances. The mental in- 
citement may be accidental without personal 
volition and initiation of it may emanate from 
things within or without the individual. Or it 
may be deliberate and carefully planned and 
emanate from the volition of another. 

The physician who employs mental sugges- 
tion in his treatment of insomnia must take 
into consideration the patient's temperament, 
his manner of life, culture, social scale, per- 
sonal and family history, specific beliefs, likes 



HYPNOTISM AND SUGGESTION 121 

and dislikes, prejudices, aversions and many 
other features of his make-up. If the pa- 
tient is religious, helpful suggestions may find 
ready lodgment in his mind while in meditation 
or in the midst of his devotions. If he is su- 
perstitious, suggestion arising from the posses- 
sion of a charm will prove effective. If he is 
credulous, some plausible explanation, weighted 
with a large measure of the obvious will induce 
a sane condition. It is the belief of the patient 
that does the work. 

Suggestion may be direct or indirect. Direct 
suggestion, verbal or personal, may be etfectual 
of itself, but most generally the suggestion that 
is most potent is indirect and extra personal 
and proceeds from the environment. Thus mu- 
sic or devotion to any art, physical exercise, 
mental work, preoccupation in a favourable love 
affair or contemplation of some sublime ideal 
may bring about a remedial state of conscious- 
ness, whether the disorder be insomnia, intro- 
spection, or organic disease. An apparently 
unstudied remark to the nurse or a member of 
the family that the patient will soon be fast 
asleep often works better than the direct sug- 



122 SLEEP AND THE SLEEPLESS 

gestion that he will not hear the clock strike 
ten because he will be asleep. This does not 
mean that direct suggestion, particularly when 
made after the patient 's mind has been prepared 
by explanation, expostulation or exhortation is 
not of value. It is, on the contrary, of great 
use and efficacy and in few conditions or states 
of mind is it more effective than in overcoming 
insomnia. The poor sleeper is so convinced 
that he will continue to ''thread a dim and per- 
ilous way through words and things" that he 
falls into a state of fear and apprehension in 
which he dreads the advent of the night. He 
asks himself the purpose of his going to bed as 
he knows he will not sleep. He envies those 
who are sleeping and is convinced, even though 
he does not admit it aloud, that he will not sleep. 
I have had such patients tell me, "I was tired 
enough to sleep and I felt sleepy, but I could 
not get it out of my mind that I would not be 
able to go to sleep." It is in such instances 
that direct suggestion works most beneficently. 
It calms the fear, counteracts the apprehension, 
uproots the conviction of inadequacy and fos- 
ters the will to sleep. It restores confidence 



HYPNOTISM AND SUGGESTION 123 

and impregnates the individual with self-reli- 
ance. Often a sleeping draught on the night 
table will act quite as efficiently as if the in- 
somniac took it. This is a most potent form 
of suggestion. The patient feels that there is 
something at hand that can rob the night of its 
terrors. His fears are cahned and he goes to 
sleep. 

Drugs or substances that are inert and that 
have no soporific virtue act in a similar way. 
The insomniac believes that he is taking some- 
thing that will make him sleep and so the mir- 
acle is accomplished with a few grains of 
bicarbonate of soda or a capsule of methylene 
blue. This is an extremely successful expedient 
with patients. The drawback to it is that the 
patient on finding that he has been deceived 
may shut himself off from all further efforts 
to reach him by suggestive methods. 

An efficacious method used by the Emman- 
uelites is to invite the insomniac to sit in a cer- 
tain chair, assuring him at the same time that 
every one of the sufferers from sleeplessness 
who has sat in that particular chair has gone 
to sleep almost immediately. 



124 SLEEP AND THE SLEEPLESS 

Many of the non-medicinal measures found 
useful in the treatment of insomnia, such as 
massage, electricity, diet and regimen act 
partly by virtue of the suggestion that accom- 
panies their emplojTnent. Of course, they do 
good of themselves hut much of their potency is 
derived from suggestion. 



ik 



CHAPTEE XIII 

READING AS A SOPORIFIC 

The principal object of those suffering from 
insomnia being to purge the mind of the 
thoughts that are parading up and down 
through it, frequently with martial accompani- 
ment, and to saturate it with gentle, peaceful, 
serene, impersonal thought that will depict the 
idyls of life without strife and passion, books 
are what most of them turn to in order to 
accomplish this end. 

There are books and books. Obviously the 
seeker after sleep will not choose for an opiate 
a stirring tale of battle or adventure. Rather 
will he select a lulling work of ponderous phi- 
losophy or of monotonous description or sooth- 
ing charm, which he may read without being 
impelled to understand, and without being in- 
tellectually or emotionally stimulated or ex- 
cited. Choice will vaiy, too, with the age, sex, 
125 



126 SLEEP AND THE SLEEPLESS 

education, and personal tastes of the individ- 
ual. 

There are books that put one to sleep by- 
boring and tiring the reader. He sleeps from 
sheer fatigue and desperation. They excite no 
thought, they arouse no emotion, they conjure 
up no imagery. They are the apotheosis of 
the commonplace, the fountain-head of all ennui, 
the limbo of all joy. By their very nature they 
are ideal for the treatment of insomnia through 
the eyes. Each insomniac must find these for 
himself. He will not have to seek for them long. 
If this be too severe a discipline, he may come 
upon books that, while neither boring nor fa- 
tiguing, will yet lead to sleep. Such books pre- 
pare the mind for sleep as rain prepares the 
soil for vegetation. When an insomniac finds 
one, he should hold fast to it, for its efficacy is 
not impaired by use. I have known Sir Thomas 
Browne's Religio Medici to operate as well the 
hundreth time as the first, and the Psalms are 
an unfailing help in time of trouble. 

There are those who have forced their way 
to oblivion by reading the sermons of Jonathan 
Edwards, but these discourses can hardly be 



. I, 



READING AS A SOPORIFIC 127 

recommended with confidence. To most peo- 
ple they lead to distressing questionings, such 
as an attempt to discover the kindliness 'and 
justice of afflicting poor wretches with a scourge 
like hysteria, and then impelling their God- 
fearing neighbours to persecute and torture 
them. Let us suggest, rather, the gentle, de^ 
lightful Amiel, for example; the humble, trust, 
ing, resigned St. Francis of Assisi; the placid, 
melancholy A. C. Benson; the revered Sir 
Thomas Browne. Each of these has written 
books that can be recommended to the casual 
and confirmed insomniac without fear of per- 
verting their literary taste, or endangering 
the much-desired mental and emotional equa- 
nimity. As a sleep-producer, however, the 
palm should perhaps be awarded to the Fa- 
miliar Letters {Epistolae Ho-Eliance) of James 
Howell. Few, I fancy, can read these epistles 
concerned with the Copemican Theory, Presby- 
terianism, or what not, without experiencing 
drowsiness. 

I am sure that I have the gratitude of 
many a poor sleeper, too, for having recom- 
mended to him A Poet at Grass, which, I 



128 SLEEP AND THE SLEEPLESS 

have somewliere read, is autobiographical of 
George Gissing. The book breathes serenity 
and contentment, and depicts the charm of life 
in the country and the spiritual peace of one 
who had kept his soul meek and his disposition 
sweet despite the pangs of penury and the 
struggles of adversity. 

For some insomniacs, Emerson's Essays and 
Poems have proved good night reading, and ex- 
cellent as a mental tranquiliser. For this same 
reason, most of the ancient philosophers are 
excellent sleep-producers. Plato's dialogues 
have, in my experience, proved helpful; Car- 
lyle's Sartor Resartus highly effective, and Wil- 
liam James ' Value of Pragmatism of almost in- 
stantaneous effect, though many will find them 
too provocative of thought or too apt to kindle 
to active antagonism. Charles Lamb and Oli- 
ver Wendell Holmes have paved the way to the 
house of Morpheus for many, and might well 
be sampled by sleep-questing night readers. 

Heroic treatment may be self-administered 
by the reading of law books, government re- 
ports, the dictionary, or the telephone book, but 
here again, what is one man's meat is another 



BEADING AS A SOPORIFIC 129 

man's poison, and individual tastes and pecul- 
iarities must determine the choice. In a gen- 
eral way, the principle may be laid down that 
any book is helpful to the insomniac which oc- 
cupies his mind sufficiently to displace vagrant, 
insistent, and harassing thoughts, and yet does 
not spur it into restless activity. 

Of course, when the insomniac is wooing 
sleep through a book, he will have made all 
preparations for surrendering his physical self 
to sleep when it does come. It will avail him 
nothing if after attaining the period of drowsi- 
ness he arouse himself by physical activity co- 
incident with disrobing. Before beginning his 
reading he will have stripped himself of cloth- 
ing down to his night habiliments. Then, when 
he feels his senses dulled and his eyelids grown 
heavy, he will have but to put out the light and 
abandon himself to the peaceful and refreshing 
slumber, which, it is the author's hope, this 
little volume may have helped him to capture. 



NOV 11 1912 



LIBRARY OF CONGRESS •f 

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